Ectopic Pregnancy Facts

8/13/2019 Ectopic Pregnancy Facts

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Ectopic pregnancy facts

An ectopic pregnancy is a pregnancy located outside the inner lining of theuterus.

Risk factors for ectopic pregnancy include previous ectopic pregnancies and

conditions (surgery, infection) that disrupt the normal anatomy of the Fallopiantubes. The major health risk of an ectopic pregnancy is internal bleeding . Diagnosis of ectopic pregnancy is usually established by blood hormone tests

and pelvic ultrasound . Treatment options for ectopic pregnancy include both surgery and medication.

What is an ectopic pregnancy?

An ectopic pregnancy (EP) is a condition in which a fertilized egg settles and grows inany location other than the inner lining of the uterus. The vast majority of ectopic

pregnancies are so-called tubal pregnancies and occur in the Fallopian tube (98%);however, they can occur in other locations, such as the ovary, cervix, and abdominalcavity. An ectopic pregnancy occurs in about one in 50 pregnancies. A molar pregnancydiffers from an ectopic pregnancy in that it is usually a mass of tissue derived from anegg with incomplete genetic information that grows in the uterus in a grape-like massthat can cause symptoms to those of pregnancy.

The major health risk of ectopic pregnancy is rupture leading to internal bleeding.Before the 19th century, the mortality rate (the death rate) from ectopic pregnanciesexceeded 50%. By the end of the 19th century, the mortality rate dropped to fivepercent because of surgical intervention. Statistics suggest with current advances in

early detection, the mortality rate has improved to less than five in 10,000. The survivalrate from ectopic pregnancies is improving even though the incidence of ectopicpregnancies is also increasing. The major reason for a poor outcome is failure to seekearly medical attention. Ectopic pregnancy remains the leading cause of pregnancy-related death in the first trimester of pregnancy.

In rare cases, an ectopic pregnancy may occur at the same time as an intrauterinepregnancy. This is referred to as heterotopic pregnancy. The incidence of heterotopicpregnancy has risen in recent years due to the increasing use of IVF (in vitrofertilization) and other assisted reproductive technologies (ARTs).

Ectopic pregnancy

An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother.
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Causes and risk factors

In most pregnancies, the fertilized egg travels through the fallopian tube to the womb(uterus). Anything that blocks or slows the movement of this egg through these tubescan lead to ectopic pregnancy:

Birth defect in the fallopian tubes Scarring after a ruptured appendix Endometriosis Having an ectopic pregnancy before Scarring from past infections or surgery of the female organs

The following also increase your risk of an ectopic pregnancy:

Age over 35 Getting pregnant while having an intrauterine device (IUD)

Had surgery to untie tubes (tubal sterilization) to become pregnant Having had many sexual partners Some infertility treatments Having your tubes tied (tubal ligation) - more likely 2 or more years after the

procedure Had surgery to untie tubes in order to get pregnant

Sometimes the cause is unknown. Hormones may play a role.

The most common site for an ectopic pregnancy is within one of the two fallopian tubes.In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix .

An ectopic pregnancy can occur even if you use birth control.

SymptomsYou may have early pregnancy symptoms, such as breast tenderness or nausea. Othersymptoms may include:

Abnormal vaginal bleeding Low back pain Mild cramping on one side of the pelvis No periods Pain in the lower belly or pelvic area

If the area around the abnormal pregnancy ruptures and bleeds, symptoms may getworse. They may include:

Fainting or feel faint Intense pressure in the rectum Low blood pressure
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Pain in the shoulder area Severe, sharp, and sudden pain in the lower abdomen

Exams and Tests

The health care provider will do a pelvic exam. This may show tenderness in the pelvicarea.

A pregnancy test and vaginal ultrasound will be done.

HCG is a hormone normally produced during pregnancy. Checking the blood level ofthis hormone (quantitative HCG blood test ) can diagnose pregnancy. If the blood levelof HCG is not raising fast enough, your doctor may suspect an ectopic pregnancy.

Treatment

Ectopic pregnancy is life-threatening. The pregnancy cannot continue to birth (term).The developing cells must be removed to save the mother's life.

You will need emergency medical help if the area of the ectopic pregnancy breaks open(ruptures). Rupture can lead to bleeding and shock, an emergency condition. Treatmentfor shock may include:

Blood transfusion Fluids given through a vein Keeping warm Oxygen Raising the legs

If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. Insome cases, the doctor may have to remove the fallopian tube.

If the ectopic pregnancy has not ruptured, treatment may include:

Surgery Medicine that ends the pregnancy, along with close monitoring by your doctor

Outlook (Prognosis)

One out of three women who have had one ectopic pregnancy are later able to have ababy. Another ectopic pregnancy is more likely to occur. Some women do not becomepregnant again.

The likelihood of a successful pregnancy after an ectopic pregnancy depends on:

The woman's age
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Whether she has already had children Why the first ectopic pregnancy occurred

Prevention

Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably notpreventable. But a tubal pregnancy may be prevented in some cases by avoidingconditions that might scar the fallopian tubes. The following may reduce your risk:

Practicing safer sex by taking steps before and during sex, which can preventyou from getting an infection

Getting early diagnosis and treatment of all infections caused by sexual relations(STDs)

Stopping smoking


Up to 1 pregnancy in 50 is ectopic, which means out of place (1, 2). In an ectopicpregnancy, the fertilized egg implants outside of the uterus, usually in the fallopian tube,and begins to grow. Rarely, an ectopic pregnancy implants in the womans abdomen,on the outside of the uterus, on an ovary or in the cervix.

What are the symptoms of an ectopic pregnancy?

Some women with an ectopic pregnancy start out with typical early-pregnancysymptoms, such as nausea and tender breasts. Others have no early symptoms andmay not know they are pregnant.

However, about 1 week after a missed menstrual period, a woman may experienceslight, irregular vaginal bleeding that may be brownish in color. Some women mistakethis bleeding for a normal menstrual period. The bleeding may be followed by pain inthe lower abdomen, often felt mainly on one side.

A woman with these symptoms should contact her health care provider promptly or goto a hospital emergency room. Without treatment, these symptoms may be followed inseveral days or weeks by severe pelvic pain, shoulder pain (due to blood from aruptured ectopic pregnancy pressing on the diaphragm), faintness, dizziness, nausea orvomiting.

How is an ectopic pregnancy diagnosed?

An ectopic pregnancy can be difficult to diagnose, so the woman needs to have severaltests. These include:

A pelvic exam
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A series of blood tests to measure the levels of a pregnancy hormone calledhuman chorionic gonadotropin (hCG). Levels of this hormone often are low in anectopic pregnancy.

A vaginal or abdominal ultrasound to locate the pregnancy. A vaginal ultrasoundoften is used because it can show the pregnancy earlier than an abdominal

ultrasound.

If these tests do not confirm an ectopic pregnancy, the provider may need to empty theuterus (a procedure called dilation and curettage or D&C) to determine whether thewoman has had a miscarriage or an ectopic pregnancy.

Occasionally, the provider may need to view the abdominal organs directly with a thin,flexible instrument called a laparoscope, which is inserted through a small incision in theabdomen while the woman is under general anesthesia.

How is an ectopic pregnancy treated?

If the provider finds an ectopic pregnancy, the embryo (which cannot survive) must beremoved so that it does not endanger the womans life. If the embryo continues to grow,it can cause the fallopian tube to rupture, resulting in life-threatening internal bleeding.Most ectopic pregnancies are diagnosed in the first 8 weeks of pregnancy, usuallybefore the tube has ruptured.

There are two treatments for ectopic pregnancy:

1. Medication: If the pregnancy is small and the tube has not ruptured, a womanmay be treated with a drug called methotrexate. The drug usually is given as a

single shot, though some women may need more than one injection.Methotrexate stops growth of the pregnancy and saves the fallopian tube. Thewomans body gradually absorbs the pregn ancy.

2. Surgery: When an ectopic pregnancy is diagnosed before the fallopian tuberuptures, the provider usually makes a tiny incision in the fallopian tube andremoves the embryo, preserving the tube. If an ectopic pregnancy is diagnosedafter the fallopian tube has become stretched, or if the tube has ruptured andbleeding has begun, the provider may have to remove part or all of the fallopiantube.

After either of these treatments, the provider monitors the woman for several weeks with

blood tests for hCG until levels of the hormone return to zero.What are the risk factors for ectopic pregnancy?

The most significant risk factor for ectopic pregnancy is sexually transmitted diseases(STDs) , such as chlamydia . STIs can lead to pelvic inflammatory disease and scarringof the fallopian tubes. Damage to the fallopian tubes increases the risk of ectopicpregnancy. Other risk factors include (1, 2, 3):
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Previous ectopic pregnancy Fertility drugs and assisted reproductive techniques (such as in vitro fertilization) Pregnancy after failed tubal sterilization Previous operations on the fallopian tube Endometriosis (when uterine tissue implants outside the uterus)

Exposure to the drug DES (diethylstilbestrol) in her mothers pregnancy Cigarette smoking

For most women, the cause of an ectopic pregnancy is unknown (3).

What is the outlook for future pregnancies?

Many women who have had an ectopic pregnancy can have healthy pregnancies in thefuture. Studies suggest that about 50 to 80 percent of women who have had an ectopicpregnancy are able to have a normal pregnancy (2, 3). The rates are about the samewhether a woman has been treated surgically or with methotrexate (1).

Women who have had an ectopic pregnancy have about a 10 percent chance of ithappening again, so they need to be monitored carefully when they attempt to conceiveagain (2).

An ectopic pregnancy occurs in about 1 in 100 pregnancies. Although many ectopicpregnancies are now treated without the need for an operation, you should always seea doctor urgently if you think you have an ectopic pregnancy. Symptoms are listedbelow but include lower abdominal pain which can become severe. A ruptured ectopicpregnancy is life-threatening, needing emergency surgery. A pregnancy is ectopic whenit occurs outside the womb (uterus) womb. Ectopic means 'misplaced'.

Understanding normal early pregnancy

An egg (ovum) is released from an ovary into a Fallopian tube. This is called ovulationand usually occurs once a month about halfway between periods. Sperm can survive inthe Fallopian tubes for up to five days after having sex. A sperm may then combine withthe ovum (fertilisation) to make an embryo. The tiny embryo is swept along a Fallopiantube to the womb (uterus) by tiny hairs (cilia). It normally attaches to the inside lining ofthe uterus and develops into a baby.

Where does an ectopic pregnancy develop?

Most ectopic pregnancies occur when a fertilised egg attaches to the inside lining of aFallopian tube (a tubal ectopic pregnancy). Rarely, an ectopic pregnancy occurs in otherplaces such as in the ovary or inside the tummy (abdomen). The rest of this leaflet dealsonly with tubal ectopic pregnancy.
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What are the problems with an ectopic pregnancy?

A tubal ectopic pregnancy never survives. Possible outcomes include the following:

The pregnancy often dies after a few days. About half of ectopic pregnancies

probably end like this. You may have no symptoms, and you may never haveknown that you were pregnant. Sometimes there is slight pain and some vaginalbleeding like a miscarriage . Nothing further needs to be done if this occurs.

The pregnancy may grow for a while in the narrow Fallopian tube. This canstretch the tube and cause symptoms. This is when an ectopic pregnancy iscommonly diagnosed.

The narrow Fallopian tube can only stretch a little. If the pregnancy grows furtherit will normally split (rupture) the Fallopian tube. This can cause heavy internalbleeding and pain. This is a medical emergency.

What are the symptoms of an ectopic pregnancy?

Symptoms typically develop around the sixth week of pregnancy. This is about twoweeks after a missed period if you have regular periods . However, symptoms maydevelop at any time between 4 and 10 weeks of pregnancy. You may not be aware thatyou are pregnant. For example, your periods may not be regular, or you may be usingcontraception and not realise it has failed. Symptoms can also start about the time aperiod is due. At first you may think the symptoms are just a late period.

Symptoms include one or more of the following.

Pain on one side of the lower tummy (abdomen). It may develop sharply, or may

slowly get worse over several days. It can become severe. Vaginal bleeding often occurs, but not always. It is often different to the bleeding

of a period. For example, the bleeding may be heavier or lighter than a normalperiod. The blood may look darker. However, you may think the bleeding is a lateperiod.

Other symptoms may occur such as diarrhoea, feeling faint , or pain on passingpoo (faeces).

Shoulder-tip pain may develop. This is due to some blood leaking into theabdomen and irritating the diaphragm (the muscle used to breathe).

If the Fallopian tube ruptures and causes internal bleeding, you may developsevere pain or 'collapse '. This is an emergency as the bleeding is heavy.

Sometimes there are no warning symptoms (such as pain) before the tuberuptures. Therefore, collapse due to sudden heavy internal bleeding issometimes the first sign of an ectopic pregnancy.

Who gets ectopic pregnancy?

Ectopic pregnancy can occur in any sexually active woman. In the UK there are around10,700 ectopic pregnancies each year.
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The chance is higher than average in the following at-risk groups:

If you have already had an ectopic pregnancy you have a slightly higher chancethat a future pregnancy will be ectopic. If you have had two or more ectopic

pregnancies, then your chances of another ectopic pregnancy are even greater. If you have kinking, scarring, damage, or other abnormality of a Fallopian tube.This is because a fertilised egg (ovum) may become stuck in the tube moreeasily. For example:

o If you have had a previous infection of the womb (uterus) or Fallopian tube(pelvic inflammatory disease ). This is most commonly due to eitherchlamydia or gonorrhoea . These infections can lead to some scarring ofthe Fallopian tubes. Chlamydia and gonorrhoea are common causes ofpelvic infection.

o Previous sterilisation operation. Although sterilisation is a very effectivemethod of contraception, if a pregnancy does occur, about 1 in 20 is

ectopic.o Any previous surgery to a Fallopian tube or nearby structures.o If you have a condition of the uterus and surrounding area

(endometriosis ). If you use a coil (intrauterine contraceptive device ). Again, pregnancy is rare as

this is a very effective method of contraception. If you are using assisted conception (some types of infertility treatments ). The risk of ectopic pregnancy increases in women over the age of 35 years and

also in smokers..


How is ectopic pregnancy confirmed?

If you have symptoms that may indicate an ectopic pregnancy you will usually be seenin the hospital immediately.

A urine test can confirm that you are pregnant. An ultrasound scan may confirm an ectopic pregnancy. This is usually an internal

(transvaginal) scan which is not painful and shows good views of the Fallopiantubes. However, the scan may not be clear if the pregnancy is very early. If this isthe case, then a repeat scan a few days later is often done.

Blood tests that show changes in the pregnancy hormones - human chorionicgonadotrophin (hCG) - are also usually done.

What are the treatment options for ectopic pregnancy?

Ruptured ectopic pregnancy
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Emergency surgery is needed if a Fallopian tube ruptures with heavy bleeding. Themain aim is to stop the bleeding. The ruptured Fallopian tube and remnant of the earlypregnancy are then removed. The operation is often life-saving.

Early ectopic pregnancy - before rupture

Ectopic pregnancy is most often diagnosed before rupture. Your doctor will discuss thetreatment options with you and, in many cases, you are able to decide which treatmentis best for you. These may include the following:

Surgery. Removal of the tube (either the whole tube or part of it) and the ectopicpregnancy is most commonly performed by keyhole surgery (a laparoscopicoperation). Removal of the Fallopian tube containing the ectopic pregnancy(salpingectomy) is usually performed if the other tube is healthy. Removal of onlya section of the tube with the ectopic pregnancy in it (salpingotomy) is usuallyperformed if the other tube is unhealthy; for example, scarred from a previous

infection. However, many women with an ectopic pregnancy do not need to havean operation.

Medical treatment. Medical treatment of ectopic pregnancies is now morecommon and avoids the need for surgery. A medicine called methotrexate isoften given, usually as an injection. It works by killing the cells of the pregnancygrowing in the Fallopian tube. It is normally only advised if the pregnancy is veryearly. The advantage is that you do not need an operation. The disadvantage isthat you will need close observation for several weeks with repeated blood testsand scans to check it has worked. You will need to have a blood test for hCGevery 2-3 days until your levels are low. Scans are usually repeated weekly.

Methotrexate can cause side-effects which include nausea and vomiting in somewomen. It can be common for some abdominal pains to develop 3-7 days afterhaving methotrexate.

'Wait and see' (expectancy). Not all ectopic pregnancies are life-threatening orlead to a risk to the mother. In many cases the ectopic pregnancy resolves byitself with no future problems. The pregnancy often dies in a way similar to amiscarriage. A possible option is to see how things go if you have mild or nosymptoms. You would need to have treatment if symptoms become worse. Also,you will need close observation and repeated scans and blood tests to check onhow things are developing.

If your blood group is rhesus negative, then you will need an injection of anti-Dimmunoglobulin if you have an operation for your ectopic pregnancy. You are rhesuspositive if you have the rhesus factor (which is a protein on the surface of your red bloodcells). If the protein is not present, you are rhesus negative. All pregnant women have ablood test to determine whether they are rhesus positive or negative. The injection ofanti-D immunoglobulin simply prevents you from producing antibodies, which can be


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harmful in future pregnancies, if you are rhesus negative. You do not need this injectionthough if you receive medical treatment.

The above is a brief description of treatment options. A gynaecologist will advise on thepros and cons of each treatment with you. One common question is - 'What is the

chance of having a future normal pregnancy after an ectopic pregnancy?' Even if oneFallopian tube is removed, you have about a 7 in 10 chance of having a future normalpregnancy. (The other Fallopian tube will still usually work.) However, 1 in 10 futurepregnancies may lead to another ectopic pregnancy. It is therefore important that if youhave had an ectopic pregnancy in the past you should go to see your doctor early infuture pregnancies.

It is common to feel anxious or depressed for a while after treatment. Worries aboutpossible future ectopic pregnancy, the effect on fertility, and sadness over the loss ofthe pregnancy are normal. Do talk with a doctor about these and any other concernsfollowing treatment.

In summary

Ectopic pregnancy is common. The pregnancy never survives. The typical first symptom is pain in the lower tummy (abdomen) after a recent

missed period. As the pregnancy grows it may tear (rupture) the Fallopian tube, requiring

emergency surgery. Planned treatment before rupture occurs is best. Most women with ectopic pregnancies do not need surgery

Ectopic Pregnancy Facts

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