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Ectopic Pregnancy

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Updated August 12, 2008

Ectopic Pregnancy Image

Ectopic Pregnancy Implanted in the Fallopian Tube

Photo © A.D.A.M.

What is an Ectopic Pregnancy?:

An ectopic pregnancy is a pregnancy that has implanted outside the uterus, usually in the fallopian tubes but sometimes on the cervix or elsewhere in the abdominal region.

Risk Factors:

A person need not have identifiable risk factors to have an ectopic pregnancy, but some known risk factors are:

  • Previous ectopic pregnancy
  • Scarring to the fallopian tubes (possibly from ruptured appendix or previous pelvic surgery)
  • Endometriosis
  • Tubal sterilization (or reversal)
  • Progestin-only birth control pills
  • Use of an IUD
  • Pelvic inflammatory disease
  • Birth defects of fallopian tubes
  • Smoking
  • History of infertility
  • In-vitro fertilization
  • Douching

In women with tubal sterilization and who use an IUD, the risk of ectopic pregnancy is still much lower than in women who use no birth control at all.

Statistics on Ectopic Pregnancy:

Statistics vary, but most estimates suggest that ectopic pregnancies happen in 1 out of every 40 to 100 pregnancies.

Symptoms of an Ectopic Pregnancy:

Ectopic pregnancies may cause cramping on one or both sides of the lower abdominal area, along with normal pregnancy symptoms such as breast tenderness, missed period, etc. Some women will have vaginal bleeding or spotting, and hCG levels may rise more slowly than expected.

An ectopic pregnancy that has ruptured will cause severe pain in the abdominal area and possibly dizziness or fainting. Some women also have shoulder pain.

When to Call the Doctor:

If you are concerned about ectopic pregnancy but not having symptoms of a rupture, call your practitioner as soon as possible for advice. If you have any symptoms of possible rupture, head to an emergency room immediately.

Diagnosis of Ectopic Pregnancies:

In addition to blood tests to check pregnancy hormone levels, your blood type and blood count, your doctor may use transvaginal ultrasound to check whether the gestational sac is visible in the uterus.

Treatment of Ectopic Pregnancies:

Sometimes doctors detect an ectopic pregnancy that is not at risk of rupturing. The doctor may prescribe a medication called methotrexate, which should cause the ectopic pregnancy to miscarry. The woman would also be closely monitored until the hCG levels had returned to zero in order to be sure that the miscarriage was complete.

If an ectopic pregnancy is at risk of rupturing or has already ruptured the fallopian tube, the treatment is surgery, because this situation is life threatening. Sometimes doctors must remove the fallopian tube, and in rare cases, perform a hysterectomy to save the woman’s life.

What to Know Going Forward:

Grieving from an ectopic pregnancy is a little different from other forms of miscarriage. On one hand, you are grieving the loss of your baby and dealing with the emotional side of pregnancy loss. On the other hand, particularly if you had emergency surgery, you may have also been through a harrowing experience and you might be feeling grateful to be alive. Balancing the two emotions can be a challenge, to say the least.

Some women particularly struggle with the idea that the developing baby may have been developing normally and had a heartbeat at the time of the surgery for the ectopic pregnancy. Even though you may know in your heart that the baby could have never gone to term, it’s normal to have mixed feelings about having to terminate.

You might encounter comments that seem to minimize your loss, such as “Just be glad they caught it in time.” Usually, people mean well but it is hard for them to know how you feel. Although on one hand, you obviously are glad that they caught in time, don’t feel like you can’t also be sad that you lost your baby.

Stay in touch with your doctor if/when you decide to try to conceive again. Ten to 20% of women will have a repeated ectopic pregnancy; your doctor may want you to come in early for a checkup in your next pregnancy to be sure that the sac is in your uterus.

A.D.A.M. Healthcare Center, Ectopic pregnancy. 15 May 2006. About.com. Accessed 9 Nov 2007.

Centers for Disease Control, "Female Sterilization: Risk of Ectopic Pregnancy After Tubal Sterilization Fact Sheet." 25 Aug. 2006. Accessed 9 Nov 2007.

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