Ectopic Pregnancy Medical Facts
All information on this page is given for research purposes only. This information is not given as a substitute for your personal care and diagnosis by a licensed physician. Under any and all circumstances, if you think that you may have an ectopic pregnancy, consult your physician immediately. Always insist that your medical professionals take your concerns seriously.
What Is Ectopic Pregnancy?
Ectopic pregnancy, also known as a tubal pregnancy, is a potentially life-threatening form of pregnancy in which implantation of the fertilized egg occurs outside the uterus. About 97% occur in the fallopian tube. The remainder implant in the abdominal cavity, on the ovary, or within the cervix.
Heterotopic pregnancies occur in one of these areas, while there is also a pregnancy in the uterus. Approximately 100,000 ectopic pregnancies occur each year. Approximately 1 in 66 women will experience this type of pregnancy.
Ectopic pregnancy is a very serious condition. When the pregnancy grows in these abnormal areas, it can easily cause massive, rapid bleeding, and even death.
What Causes Ectopic Pregnancy?
The most likely reason for the occurrence of an ectopic pregnancy, is a ruptured Fallopian tube. This can be due to a number of things:
- history of pelvic inflammatory disease (PID) or other sexually transmitted diseases-which accounts for about 30-50% of all ectopic pregnancies (ampulla damage)
- history of pelvic surgery (scar tissue outside the tube may causes constriction on the tube)
- history of tubal surgery
- fertility being restored through the reverse of tubal ligation
- tubal ligation itself
- tumors or cysts in the tubes
- fibroids in the uterus (which block the tube’s entrance into the uterus)
- endometriosis of the fallopian tube
- smoking (may damage the ampulla of the fallopian tube)
- assisted reproduction techniques (IVF, GIFT, ZIFT, superovulation)
- history of ectopic pregnancy
- congenital defects in the structure of the tubes (e.g. exposure to diethylstilbestrol (DES) in utero)
- hormonal imbalance (excessive levels of progesterone or estrogen may interfere with the contractions of the fallopian tube)
- there is also a slightly increased risk of a pregnancy being ectopic in the case of a women conceiving while having an intra-uterine contraceptive device (IUD) in place. While there is a higher percentage of ectopic pregnancy in IUD users, the IUD does not cause it. Rather, it functions to prevent uterine pregnancies, so that any fertilization that does occur results in an ectopic pregnancy
“Ampulla” are the nodes inside the fallopian tube that push the embryo down into the uterus. You CAN NOT cause yourself to have an ectopic pregnancy. If possible, avoid the risks factors before you get pregnant. You may be able to significantly decrease your chances of having an ectopic pregnancy. However, an ectopic pregnancy is not always the result of an obvious defect. It can be a “fluke”–most women who are diagnosed with an ectopic pregnancy do not have a recognizable risk factor or diagnosis. Pray that this is true in your case, but please take all cautionary measure available before attempting to conceive again.
What Are The Maternal Risks Of Ectopic Pregnancies?
They are the second leading cause of pregnancy-related deaths in the first trimester and account for 9% of all pregnancy-related deaths in this country.
If left untreated, an ectopic pregnancy may be potentially life-threatening, as there is a chance of the tube bursting, resulting in serious and life threatening internal bleeding.
What Are The Symptoms Of an Ectopic Pregnancy And How Is It Diagnosed?
They are sometimes difficult to diagnose. A risk of ectopic pregnancy is suspected if a woman has symptoms of a late menses, irregular vaginal bleeding, or abdominal pain. Shoulder pain and a feeling of rectal pressure is also associated with ectopic pregnancy. However, some women have no symptoms (other than those of pregnancy), making the diagnosis difficult at times.
Can I risk another pregnancy after a previous ectopic pregnancy?
A sensitive pregnancy test (HCG) can determine whether a normal pregnancy is “healthy” or not. Women with risk factors for, previous history or more serious symptoms of ectopic pregnancy should be closely monitored with HCG blood tests (approximately 12 days after conception and up to 5-6 weeks after conception). In a healthy pregnancy, these levels rise in a definite pattern (doubling about 66% every two days). An ectopic pregnancy may be suspected when levels do not rise appropriately.
A pelvic ultrasound is often used to determine the presence or absence of a pregnancy within the uterine cavity. Approximately 5-6 weeks after the last menstrual period, the use of ultrasound can determine if there is a gestational sac in the uterus. The ultrasound may even detect fallopian tube ruptures or the presence of a pelvic mass, representing an ectopic pregnancy.
Ask for a printout or a copy of the ultrasound. You may later be glad that you did!
If an ectopic pregnancy cannot be determined with an ultrasound, laparoscopy (a small, lighted camera inserted through small incisions below the navel and/or near the pubic bone) would prove more effective.
Today, ectopic pregnancy is diagnosed and immediate treatment is begun prior to tubal rupture in over 80 percent of affected women.
What Can Be Done When Ectopic Pregnancy Is Diagnosed?
Sadly, at this time, even a viable ectopic fetus cannot be saved. About 25% of all those affected pregnancies resolve themselves before a pregnancy has even been confirmed. When the diagnosis is made, the ectopic pregnancy treatment options need to be considered. In some situations, emergency surgery is required to control severe internal bleeding. If, however, the diagnosis is made early in the pregnancy and prior to tubal rupture, medical management is an alternative.
If it is discovered in the unruptured state, a drug called Methotrexate (which prevents the rapid division of cells in the early pregnancy) can be injected (one or more times). This treatment requires close monitoring of HCG levels in the blood. Methotrexate treatment may not be suitable for all patients. HCG levels are then carefully monitored to ensure that they fall appropriately.
The HCG level should return to zero in approximately four weeks. Side effects (diarrhea, mild irritation of the mouth or stomach, elevated liver enzymes) occur in about 4% percent of women treated with Methotrexate. Methotrexate may fail to resolve the ectopic pregnancy, and tubal rupture may occur. However, with careful monitoring, rupture may be avoided. The advantages of Methotrexate therapy include less tubal damage, less expense, and an increase in the possibility of future fertility.
NOTE: New research suggests that high amounts of folic acid in the blood can inhibit methotrexate from working properly. If you are diagnosed with an ectopic pregnancy, and will be taking methotrexate, do not take prenatal vitamins. As more research surfaces, we will provide it here.
Many ectopic pregnancies are diagnosed in the emergency room, when the woman comes in with severe symptoms like pelvic pain and perhaps dizziness due to the rupture of the tube and major internal bleeding. This necessitates more invasive surgery and may require removal of the entire tube, but not usually not the ovary.
Removal of the Fallopian Tubes?
During a laparotomy (whereby an approximately 5 cm incision is made across the lower abdomen), either a salpingostomy (the pregnancy is removed through a small incision in the tubal wall and tube is repaired), a Tubocornual Anastmosis (the portion of the tube containing the ectopic is removed, and the remaining portion is reattached to the uterus), or a Tubotubal Anastmosis (a section of the tube is removed and the two severed pieces are then stitched back together) may be performed.
However, there is data suggesting that repaired tubes have a higher rate of recurrent ectopic pregnancy (in the same tube). A salpingectomy (removal of the Fallopian tube, if the ectopic has already caused irreversible damage to the tube or the tube has burst) may be necessary.
In some cases, wherein the pregnancy has embedded itself into the uterus, a hysterectomy is necessary. However, this is the exception, and NOT the rule.
Sadly, the resolution has no happy ending. However, there is research being done on the movement of an ectopic pregnancy into the uterus. The data on this research is “sketchy”, but when conclusive information is available, I will include in in this section.
What About Subsequent Pregnancies?
Your recovery time from the “resolution” of an ectopic pregnancy depends upon what type of procedure was performed. Your physician will be able to give you a time line regarding your future attempts at conception.
There are no statistics (regarding subsequent pregnancies by natural conception) given in this section for several reasons: data changes from study to study, the results of these studies are hard to interpret (when compared to others), and every woman’s body is different. I may later provide results from several independent studies, if I receive numerous requests for such data.
There is a possibility that you may have another ectopic pregnancy (estimated at a 12% recurrence rate), therefore your next pregnancy would need careful monitoring-HCG testing and ultrasound scanning in the early weeks of a pregnancy will offer peace of mind.
If you have undergone a salpingectomy and provided the other tube is normal, there is still a good chance of conception taking place, although it may take a little longer.
There are precautionary tests that should be done prior to conceiving again after an ectopic pregnancy. Your physician might recommend one of the following.
We recommend that you consider consulting with a Reproductive Endocrinologist (R.E.), who may be better able to assist you in getting pregnant in the future. An R.E. not only provides assisted reproductive technologies. They are educated in the field and can perform the testing necessary to predict possible future ectopic pregnancies. Most insurance companies cover the cost of diagnostic testing (especially after an ectopic). Be sure to check with your insurance provider before making an appointment, if you will not be able to pay the consultation fee(s).
- Hysterosalpingogram (HSG): dye (usually iodine based) is inserted into the uterus through the vagina with a catheter. Upon X-ray, the uterus and fallopian tubes are visible. The HSG can reveal abnormalities of the uterus (LIST) and fallopian tubes (blockages and hydrosalpinx). Ideally, in determining tubal patency, the dye should easily flow out of the fallopian tubes and into the abdominal cavity. Complications may include infection. Infection is infrequent, and is a possible complication for any type of procedure wherein a foreign substance or instrument is introduced into the reproductive tract. Side-effects may include cramping and vaginal bleeding.
- Sonohysterography (SHG): Similar to the HSG in purpose and performance, a small amount of liquid (usually saline based) is inserted into the uterus through the vagina with a catheter. Upon ultrasound, the uterus and fallopian tubes are visible. Ideally, in determining tubal patency, the dye should easily flow out of the fallopian tubes and into the abdominal cavity. Complications may include infection. Infection is infrequent, and is a possible complication for any type of procedure wherein a foreign substance or instrument is introduced into the reproductive tract. Side-effects may include cramping and bleeding.
While the HSG and SHG are similar in purpose and performance, the SHG can be more expensive. This may be due to the use of the ultrasound instead of the x-ray. Be sure to check with your insurance provider (to confirm coverage) before scheduling. The SHG has benefit for those who may be allergic to iodine. Also, the SHG involves no exposure to x-ray. However, with both the HSG and SHG, the condition of the lining of the fallopian tube is not apparent. The lining of the fallopian tube “coaxes” the embryo down into the uterus, and damage to the lining may prevent it from doing so.
- Falloscopy (performed in conjunction with a laporoscopy): a scope is inserted into the fallopian tube (through the fimbria) to examine the lining. The lining of a healthy fallopian tube looks like a small mountain range of projecting, moving nodes. Areas without nodes or damaged nodes (flat and/or non-moving), indicate risk for ectopic pregnancy.
We have been told that there are (sometimes) therapeutic effects from the HSG, SHG, and falloscopy. It is possible that during these tests, small blockages may be forced out of the fallopian tube. Another RISK of these tests is the unintentional dislodge of a pregnancy. However, this risk can be avoided if performed several days after a menstrual period, and in combination with HCG urine and blood testing.
There are also corrective surgeries that can be performed on a damaged fallopian tube (that was not fully repaired during the diagnosis or removal of the ectopic pregnancy). Based on my research, data on these surgeries is inconclusive pertaining to success (future pregnancy rate) and rate of future ectopic (in the damaged/repaired tube). Discuss these options with your physician. For more information on corrective surgery of the fallopian tube, visit ivf.comIf your doctor has given you the “go ahead” to attempt to conceive naturally, keeping track of your cycles by charting your temperature with a basal thermometer is a valuable tool. Taking Charge of Your Fertility by Toni Weschler, MPH explains the charting process, other ovulatory signs, and provides wonderful information about a woman’s cycle in general. I learned a lot from this book!
Some women who have suffered an ectopic pregnancy will not be able to conceive naturally again. This is sometimes true for women in whom both fallopian tubes were left intact. Unfortunately, the reasons are for this infertility are not always determinable.
When preparing for another pregnancy, learn all that you can about your body and what may lie ahead for you.
Those considering adoption should consider seeking qualified, licensed counsel to determine if adoption is right for them and to emotionally prepare themselves for an adoption. Should you decide that adoption is right for you, we also urge you to seek the services of a licensed attorney.
Ask questions of qualified personnel. If you feel that your questions are not being answered, change personnel. This is your body, and your life. Hurting someone’s feelings (by changing physicians, counselors, attorneys) should not be an issue.