Ectopic Pregnancy

Definition
Ectopic means "out of place." In an ectopic pregnancy, a fertilized egg has implanted outside the uterus. The egg settles in the fallopian tubes more than 95% of the time. This is why ectopic pregnancies are commonly called "tubal pregnancies." The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies.

None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy never develops into a live birth.

What Are the Signs and Symptoms?
Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination.

Pain is usually the first red flag. You might feel pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and stabbing. It may concentrate on one side of the pelvis, and it may come and go or vary in intensity.

Any of the following additional symptoms can suggest an ectopic pregnancy:

  • vaginal spotting or bleeding
  • dizziness or fainting (caused by blood loss)
  • low blood pressure (also caused by blood loss)
  • lower back pain
What Are the Options for Treatment?
Treatment of an ectopic pregnancy varies, depending on its size and location and whether you want the ability to conceive again.

An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which dissolves the fertilized egg and allows your body to reabsorb it. This nonsurgical approach minimizes scarring of your pelvic organs.

Conservative management of ectopic pregnancy requires close observation of the patient & HCG monitoring.

If the pregnancy is further along, you'll likely need surgery(Laparoscopic/ Lapatotomy) to remove the abnormal pregnancy.

What About Future Pregnancies?
Approximately 30% of women who have had ectopic pregnancies will have difficulty becoming pregnant again. Your prognosis depends mainly on the extent of the damage and the surgery that was done.

If the fallopian tube has been spared, the chances of a future successful pregnancy are 60%. Even if one fallopian tube has been removed, the chances of having a successful pregnancy with the other tube can be greater than 40%.

The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another.

Management of Ectopic Pregnancy