McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
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What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that takes place outside the uterus. The most common site of an ectopic pregnancy is one of the fallopian tubes. An ectopic pregnancy in the fallopian tubes is called a tubal pregnancy. Sometimes the pregnancy develops in the ovary and, rarely, in the abdominal cavity or cervix.

An ectopic pregnancy threatens the life of the mother and must be ended as soon as possible.

How does it occur?

An ectopic pregnancy is usually associated with some condition that blocks the passage of the fertilized egg into the uterus. These conditions include:

• a previous infection in the fallopian tubes that caused scar tissue
• surgery on the tubes, ovaries, or a ruptured appendix
• abnormalities in the fallopian tubes or the genitourinary tract you may have had at birth
• a previous ectopic pregnancy
• a pelvic tumor that interferes with the fallopian tubes
• certain birth control methods, such as IUDs.

If you know you have any of these conditions, you should see your doctor as soon as you think you might be pregnant.

What are the symptoms?

Ectopic pregnancies are usually diagnosed within the first 2 months of pregnancy, possibly before a woman realizes that she is pregnant. The symptoms may be mild or they may be severe and dangerous. They can be the same as the symptoms of other conditions that are less serious. Possible symptoms of an ectopic pregnancy are:

• missed period or abnormal vaginal bleeding
• pain in the lower abdomen or pelvis
• symptoms of pregnancy such as breast tenderness, morning sickness, etc.

Rupture of an ectopic pregnancy is life threatening. The symptoms include:

• sudden increase in pain
• symptoms of oncoming shock: pale skin, fast heart rate, and dizziness and possible fainting from low blood pressure caused by bleeding
• shoulder pain from irritation of the diaphragm caused by bleeding into the abdomen.

How is it diagnosed?

Certain blood tests can detect an ectopic pregnancy before symptoms develop. In addition to blood tests and a pregnancy test, the following procedures may be done:

• Ultrasound scan to see if the fertilized egg is in the uterus or a fallopian tube.
• Culdocentesis, which is the insertion of a needle through the vagina behind the uterus, to look for blood in the pelvis that could indicate a ruptured fallopian tube.
• Laparoscopy, which is the insertion of a lighted instrument into the abdomen through an incision in the belly button to look at the pelvis and tubes. An ectopic pregnancy can be seen even before it ruptures and may be removed with laparoscopy instruments.

How is it treated?

If an ectopic pregnancy is diagnosed very early in pregnancy (within the first 6 weeks of pregnancy), it can be treated with medication (methotrexate). Otherwise, the doctor will perform surgery to remove the pregnancy. In some cases this surgery can be done through a laparoscope. Abdominal surgery (laparotomy) may be needed if there is heavy bleeding into the abdomen and if the fallopian tube has ruptured and needs repair. Any damaged tissue, such as all or part of a fallopian tube, will be repaired or removed.

If you are in shock and very sick or unstable, you must have surgery immediately to stop internal bleeding. If you lose a lot of blood, you may need blood transfusions.

How long will the effects last?

The effects last as long as the ectopic pregnancy exists. Without treatment this condition can cause serious problems, including death.

How can I take care of myself?

The best way to take care of yourself is to pay close attention to your health. Monitor physical changes and symptoms related to your menstrual cycle, and tell the doctor about any abnormal bleeding or unusual pain between menstrual periods.

How can I prevent an ectopic pregnancy?

Pelvic inflammatory disease is the most common, preventable factor associated with ectopic pregnancy. Sexually transmitted diseases, such as gonorrhea and chlamydia, can cause pelvic inflammatory disease. Infection can damage the fallopian tubes and make an ectopic pregnancy more likely. Avoid such infections by following safe sex practices.

Not all ectopic pregnancies can be prevented, but reporting any suspicious symptoms immediately to a doctor can help prevent serious problems and complications if an ectopic pregnancy does occur.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.