Ectopic Pregnancy

Ectopic Pregnancy

What is an ectopic pregnancy?

Most often when a woman becomes pregnant, the fertilized egg travels to the woman’s uterus where it becomes attached and begins to grow. Sometimes, however, pregnancies grow outside the uterus. This is called an ectopic pregnancy. The most common site of ectopic pregnancy is in the fallopian tube.

What causes ectopic pregnancy?

The exact cause of an ectopic pregnancy is not always known. There are conditions that make ectopic pregnancy more likely to occur. Conditions that result in damage to the fallopian tube are suspected to be the main cause of ectopic pregnancy which may include:

    • Pelvic infection: infection of uterus, tubes, appendix
    • Pelvic inflammatory disease
    • Endometriosis
    • Previous surgery to the tubes: sterilization, removal of a part of the tube, repair of a damaged tube
    • Previous ectopic pregnancy
    • Previous surgery in the abdomen
    • Other conditions that increase the risk are Sexually transmitted diseases, Cigarette smoking, Increased age of the mother

What are the symptoms of ectopic pregnancy?

      • Abnormal vaginal bleeding: irregular bleeding that occurs when you are not due for a normal menstrual period.
      • Abdominal pain: usually of sudden onset but can be intermittent or continuous, usually in the lower pelvis.
      • Faintness or dizziness of sudden onset especially when there is accompanying abdominal pain
      • Shoulder pain in association with symptoms described above can be a symptom of bleeding in the abdomen

These symptoms are particularly important if you suspect you could be pregnant or you have one or more of the risk factors described above.

How is ectopic pregnancy diagnosed?

The immediate step is to make sure your blood pressure and pulse are normal. A thorough examination including a pelvic examination is important. This step will determine whether you are bleeding inside the abdomen and how quickly we must act to stop the bleeding.

The next step is to confirm that you are pregnant. This is usually done with a urine pregnancy test.

Then we do tests to find out where the pregnancy is located. This is best done with an ultrasound examination. A vaginal probe ultrasound is often necessary to look closely at the uterus, tubes and ovaries since the pregnancy is very small at this stage.

We may also need to check the level of pregnancy hormone called HCG (human chorionic gonadotropin) since the hormone level increases with the duration of pregnancy and a normal rise in the level of HCG suggests a normal pregnancy within the uterus even before the pregnancy can be seen on ultrasound examination.

How is ectopic pregnancy treated?

Ectopic pregnancy can be treated medically or surgically. In addition, you may need transfusion of blood products if you have severe blood loss.

Surgical treatment of ectopic pregnancy:
Most common surgery is called laparoscopy. Under general anesthesia, through a small cut, a thin telescope is inserted into the belly and two or more additional small cuts are made to insert thin instruments with which we can separate and then remove the ectopic pregnancy.

Sometimes, especially when there is an urgent need to control bleeding or when laparoscopy is not considered safe, a larger cut may be needed to accomplish the removal of ectopic pregnancy. This procedure is called laparotomy.

The removal of ectopic pregnancy, with laparoscopy or laparotomy, may be accomplished by making a small slit on the fallopian tube or removing part or all of the tube depending on how much of the tube is affected.

Medical treatment of ectopic pregnancy:
Methotrexate is a medicine that has been used to treat an early, intact ectopic pregnancy that has not yet burst through the wall of the fallopian tube. This treatment is successful in roughly 94% of patients. We will make sure that you are a candidate for this treatment by checking your blood count, HCG level, liver and kidney function tests. If you are eligible to have Methotrexate therapy, you will receive the medicine as an injection. You have to come back for blood tests 4 days and 7 days after the injection and every week thereafter until the HCG level is no longer detectable in your blood. This may take several weeks.
Occasionally you may need a second dose of Methotrexate if your HCG level does not fall fast enough. Methotrexate treatment, when successful, avoids surgery and most often results in the affected fallopian tube to remain open. However, the Methotrexate treatment can fail and you may need urgent intervention to surgically remove the ectopic pregnancy.

Expectant management of ectopic pregnancy:
Sometimes, we cannot determine exactly where the pregnancy is and we may have to follow the pregnancy with a series of blood tests for the HCG hormone. If the HCG level is falling on its own, you have no symptoms that indicate bleeding in the abdomen and your examination and ultrasound findings concur, we may recommend just continuing to watch closely rather than treat you medically or surgically.

Can I get pregnant after treatment for ectopic pregnancy?

If you have at least one open fallopian tube, your chances of future pregnancy are good. However, your risk for another ectopic pregnancy is increased and you should seek care early in future pregnancies.