Ectopic Pregnancy
(Tubal Pregnancy)

Picture of an ectopic pregnancy

What is the medical definition of ectopic pregnancy?

• An ectopic or tubal pregnancy is a pregnancy that develops outside a woman's uterus (womb). This happens when the fertilized egg from the ovary does not reach or implant itself normally in the uterus. The products of this conception are abnormal and cannot develop into fetuses.
• The most common place that ectopic pregnancy occurs is in one of the Fallopian tubes (a so-called tubal pregnancy). Ectopic pregnancies also can be found on the outside of the uterus, on the ovaries, or attached to the bowel.
• The most serious complication of an ectopic pregnancy is rupture. Leading to intra-abdominal hemorrhage (severe bleeding).

What is the first sign of an ectopic pregnancy?

• The most common signs and symptoms of a tubal pregnancy are abdominal pain and vaginal bleeding.

How soon would know if you had an ectopic pregnancy?

• Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy.
• An ultrasound imaging test is a common diagnostic test for ectopic pregnancy.
• There are both medical and surgical treatments available for ectopic pregnancy.
• Ectopic pregnancy is the leading cause of pregnancy-related deaths in the first trimester of pregnancy in the US.

Ectopic or tubal pregnancy is caused when a fertilized egg lodges in a Fallopian tube or other location instead of continuing its journey to the uterus, where it is supposed to implant. The egg can become stuck when a Fallopian tube is damaged, scarred, or distorted.

Common conditions that are known risk factors for ectopic pregnancy include:

• Previous tube infections (salpingitis), such as pelvic inflammatory disease (PID), chlamydia, and gonorrhea
• Previous surgery inside the abdomen, especially involving the Fallopian tubes, ovaries, uterus, lower abdomen, or bowels (Local surgery to the outside of the cervix is not a risk factor.)
• Use of fertility medications at the time of conception
• Prior history of tubal pregnancy
• The use of an intrauterine device (IUD) does not increase the risk of ectopic pregnancy. However, a normal pregnancy is less likely with an IUD in place, so if a woman becomes pregnant while using an IUD, it is more likely the pregnancy is not inside the uterus.

Symptoms of an ectopic pregnancy are often confused with those of a miscarriage or pelvic inflammatory disease.

The most common symptoms of a tubal pregnancy are abdominal and pelvic pain and vaginal bleeding. A ruptured ectopic pregnancy is a true medical emergency. If you suspect you have a ruptured ectopic pregnancy, call 911. Common symptoms of a ruptured ectopic pregnancy include the following:

• Lightheadedness, dizziness, almost passing out, loss of consciousness
• Pale complexion, clammy-feeling skin
• Sweaty
• Fast heartbeat (over 100 beats per minute)
• Abdominal or pelvic pain so severe that the woman can't stand up

If you are pregnant and experience any unusual abdominal pain or vaginal bleeding, contact a medical professional immediately. If your health care professional cannot be reached, or if your symptoms become worse, go quickly to a hospital's emergency department.

You must go to a hospital's emergency department for any of the following reasons:

• Severe abdominal pain
• Heavy vaginal bleeding
• Passing out or loss of consciousness
• Dizziness when standing
• If you are unable to reach your health care professional in a timely manner

Your health care provider or an emergency doctor will want to confirm pregnancy with an HCG test if this has not already been done.

• If you have severe pain or heavy vaginal bleeding, IV lines will be started. Oxygen will be given, and blood tests will be ordered.
• The doctor will perform a pelvic exam.
• An ultrasound of your pelvis will probably be ordered to determine where the pregnancy is located. An ultrasound is a form of imaging using sound waves. Ultrasound is not painful. It is performed by placing a handheld device, or probe, which is connected to a television monitor, against the lower abdomen. A more sensitive ultrasound test is performed using a special probe inside the vagina (birth canal).
• If the bleeding is severe or becomes life-threatening, you may be taken immediately to the operating room.
• Sometimes the pregnancy has not developed sufficiently to be seen by ultrasound. If the bleeding and pain are not severe, the doctor may recommend you have special blood tests every 2-3 days to monitor the pregnancy until it has grown large enough so that it should be visible. Another ultrasound will likely be performed at that time to make sure the pregnancy is in the uterus and developing normally.

Ectopic pregnancy is not normal and does not represent a developing baby. This condition can be life-threatening and must be corrected. Your health care professional will discuss which treatment is best.

• Formerly, surgery was the only option for treatment of ectopic pregnancy. However, in recent years, if the ectopic pregnancy is in the Fallopian tube and is very small, the patient may be given medical treatment in the form of methotrexate (Rheumatrex, Trexall) therapy to cause the tissue to stop growing and allow the body to expel it.
• Methotrexate is a chemotherapeutic drug that interferes with cell division and growth and has been successfully used in the treatment of leukemias, lymphomas, and other cancers. It also has been used as an immunosuppressive agent in the prevention of graft versus host disease in transplant recipients and in the treatment of severe psoriasis and rheumatoid arthritis. Methotrexate is given for ectopic pregnancy in the form of single or multiple intramuscular injections.
• Most women who undergo this therapy describe lower abdominal pain, especially within the first several days, and vaginal bleeding similar to a heavy menstrual period will occur. The patient will be advised to have blood tests every 3 days to ensure that the medication has been effective.

If the ectopic pregnancy is large or outside the Fallopian tube, or if there are signs of severe bleeding inside the abdomen, surgery is required. Often the surgeon can use laparoscopic surgery (small incisions in the abdomen to remove the ectopic tissue), but sometimes a larger incision is required. In the case of a tubal pregnancy, if the tube has not ruptured, sometimes it is possible to extract the tissue from the tube. Often, however, tubal damage is so great that the Fallopian tube must be removed.

Obstetrician-gynecologists (OB-GYNs) are the specialists typically involved in the treatment of ectopic pregnancy. If the female is seen in an emergency department, the initial evaluation may be performed by an emergency medicine specialist.

Ectopic pregnancy generally is not preventable. However, it is possible to decrease some of the risk factors for developing an ectopic pregnancy:

• If you are diagnosed with pelvic inflammatory disease, take the prescribed antibiotic as directed until it is completely resolved, then follow up with your doctor to be certain you are cured.
• Avoid gonorrhea, chlamydia, and other sexually transmitted diseases
• If you plan to get pregnant soon and you are using an intrauterine device (IUD) for contraception, discuss this with your health care professional.
• Surgery of the reproductive system, bowels, or lower abdomen can lead to scarring, which increases your risk of ectopic pregnancy.

The chance of recovery from ectopic or tubal pregnancy is very good if it is diagnosed and treated early. Having had an ectopic pregnancy increases the likelihood that a subsequent pregnancy also will be ectopic. Talk with your health care professional (an obstetrician is a medical specialist) about your concerns for future fertility, and your risk of another ectopic pregnancy. Should you become pregnant again, contacting your health care professional early on is very important to obtain the necessary tests to make sure your pregnancy is inside the uterus.