Ectopic Pregnancy

Ectopic pregnancy is a pregnancy that is not in the usual place within the uterus but develops outside the uterus (womb). The most common place that ectopic pregnancy occurs is in one of the fallopian tubes (tubes that carry eggs from the ovaries to the uterus). Rarely, an ectopic pregnancy takes place in the abdomen, ovary or neck of the uterus (cervix).

An ectopic pregnancy happens when a fertilized egg gets stuck on its way to the uterus. This may be caused when the fallopian tube has been scarred, damaged or the shape is changed. Factors that can increase your risk for an ectopic pregnancy include:

  • History of fallopian tube infection such as pelvic inflammatory disease (PID), chlamydia and gonorrhoea
  • Previous ectopic pregnancies
  • Previous surgery on the fallopian tubes or in the pelvic area
  • Taking fertility medications around the time of conception
  • Women who get pregnant while an intrauterine device (IUD) is in place

If you have an ectopic pregnancy you may experience abnormal vaginal bleeding, absence of menstrual periods (amenorrhea), breast pain, lower back pain, nausea, lower abdominal or pelvic pain and mild cramping on one side of the pelvis.

If you have a ruptured ectopic pregnancy you may have fainting, shoulder pain, intense pressure in the rectum, severe lower abdominal pain and low blood pressure.

To diagnose ectopic pregnancy your doctor will perform a pelvic examination. Your doctor may check your human chorionic gonadotropin (hCG) levels. An abnormal rise in blood hCG levels may indicate an ectopic pregnancy. If an ectopic pregnancy is suspected, you will probably also have ultrasounds of your pelvis to visualize the location of pregnancy. A more sensitive ultrasound test may be done using an intravaginal probe (special probe inside the vagina). A laparoscopy can also be performed to provide diagnosis and treatment.

Treatment choice for an ectopic pregnancy depends on the size and location of the pregnancy. Treatment options include nonsurgical and surgical methods. If the ectopic pregnancy is in the fallopian tube and the embryo is still relatively small, you may be given medications to stop the growth of the embryo. These medications dissolve the fertilized egg without doing any harm to your fallopian tubes or other organs. As the medications begin to work you may have abdominal pain and vaginal bleeding especially within the first several days. Your doctor will monitor your hCG blood levels to make sure that the ectopic pregnancy has been completely removed and no further treatment is needed. If the pregnancy is continuing or if you have certain health conditions indicating that medications should not be used you will likely need surgery to remove the abnormal pregnancy. Surgical intervention may also be necessary if the tube has ruptured, damaged or if there is severe bleeding inside the abdomen. The ectopic pregnancy may be removed using laparoscopy, a less invasive surgical procedure. During this surgery a long thin tube attached with a camera, called laparoscope is passed into the abdomen through a small incision. This enables your surgeon to observe the ectopic pregnancy and remove it.

Women who have had one ectopic pregnancy are later able to have a successful pregnancy. If your fallopian tubes are not damaged after an ectopic pregnancy, then you have better chances of conceiving again, but you will be at higher risk of ectopic pregnancy. If one of the tubes ruptured or was badly damaged or removed, you still have chances of conceiving again.

When you do become pregnant again, see your doctor as soon as you can to check that your pregnancy is developing in the right place.