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ectopic pregnancy

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Female reproductive organs

Alternative Names
pregnancy in the fallopian tube, tubal pregnancy, extrauterine pregnancy

An ectopic pregnancy occurs when a fertilised egg implants outside of the uterus. The most common site is within a fallopian tube. More rarely an embryo may implant within an ovary, in the cervix, or on the abdominal wall.

What is going on in the body?
One out of every 200 pregnancies is ectopic. Although the fertilised egg is not cradled within the uterus, the embryo continues to grow and expand.

Most ectopic pregnancies occur in a fallopian tube. Without treatment, the tube can rupture. That can cause many serious problems and sometimes death.

Four of out 10 ectopic pregnancies occur in women between 20 to 29 years old. Over 90% of these cases are diagnosed before the 12th week of pregnancy.

What are the signs and symptoms of the condition?
If a woman has an ectopic pregnancy, she may:
  • have no period
  • have irregular vaginal bleeding, or spotting
  • feel lower abdominal or pelvic pain on one or both sides that grows worse over time
  • feel pain deep in her pelvis during sex
  • notice pregnancy symptoms, such as breast tenderness and nausea
If a rupture occurs, a woman may:
  • feel severe pain in her lower belly
  • develop shoulder pain triggered by internal bleeding
  • feel dizzy and notice a whirling sensation
  • faint or pass out
What are the causes and risks of the condition?
Usually, an ectopic pregnancy occurs when a fertilised egg is slowed or blocked in some way as it travels down the tube to the uterus. The stage may be set for this by:
  • pelvic inflammatory disease (PID).
  • misshapen tubes.
  • endometriosis
  • surgery on a tube, such as tubal sterilisation.
  • fibrous bands in or between organs called adhesions due to prior surgery. Examples of these surgeries are removal of the appendix or an ovarian cyst.
  • a history of infertility.
  • an earlier ectopic pregnancy.
  • an intrauterine device (IUD).
  • a pelvic mass, such as a fibroid or ovarian cyst, that interferes with the tubes.
  • a pregnancy that occurs while taking the progesterone-only "Mini-Pill."
What can be done to prevent the condition?
Not every ectopic pregnancy can be prevented. However, a woman should avoid risk factors that make ectopic pregnancy more likely to occur, including:
  • sexually transmitted diseases (STDs), such as chlamydia and gonorrhoea. These STDs can cause PID and adhesions that block the tubes. Practicing safer sex can help a woman avoid STDs.
  • an IUD. If a woman has had PID, it is safer to choose another type of birth control.
If a woman who has had tubal sterilisation has a positive pregnancy test, she probably has an ectopic pregnancy. She needs further tests right away.

How is the condition diagnosed?
Tests that may be done to help diagnose an ectopic pregnancy include:
  • a test that checks levels of a pregnancy hormone.
  • ultrasound with a vaginal probe. This lets the technician or doctor find an embryo and foetal heartbeat by 4 to 5 weeks, possibly in the tube. Any blood in the pelvis can also been seen.
  • putting a needle into the abdomen through the top of the vagina to tap any leaking blood from a ruptured ectopic pregnancy. This is rarely done
  • laparoscopy, which involves placing a tiny, lighted scope into the abdomen through a small incision below the belly button. This is done under general anaesthesia. It allows the surgeon to check the pelvic organs for an ectopic pregnancy and treat the problem.
An ectopic pregnancy is usually missed if an ultrasound picks up another embryo in the uterus. This is very rare, though. It happens in only 1 in 25,000 pregnancies, with a high rate in IVF pregnancies.

What are the long-term effects of the condition?
A woman's symptoms will last and grow worse as long as the ectopic pregnancy exists. A rupture causes more pain and serious problems if not diagnosed and treated.

Long-term effects depend upon whether delayed diagnosis or rupture occurs. These effects can include:
  • removal of the affected tube. This causes infertility in about 40% of cases.
  • risks from blood transfusions.
  • a chronic infection in a tube called salpingitis.
  • intestinal blockages.
  • death, which occurs in 1 in 1,000 cases.
When surgery is done to treat a ruptured ectopic pregnancy, a later, normal pregnancy is possible in about half of the cases. Otherwise, infertility occurs.

What are the risks to others?
This condition is not contagious.

What are the treatments for the condition?
Treating this problem early can help prevent a rupture and other serious side effects. Treatment options depend upon how soon the diagnosis is made, whether or not rupture has occurred, and the location of the ectopic pregnancy.

A woman with a very early tubal pregnancy that has not ruptured may be given methotrexate through a vein in her arm. This drug destroys the pregnancy. The woman would then be monitored closely in the hospital through blood tests and hormone levels to make sure that the pregnancy has ended.

Laparoscopy may be used to diagnose and treat an ectopic pregnancy if there is no tubal rupture or emergency. By using tiny instruments to remove the pregnancy, a surgeon may be able to preserve the affected tube. The embryo cannot be implanted afterwards in the uterus to keep growing. This method requires a short overnight stay in the hospital.

A woman needs emergency treatment if an ectopic pregnancy has ruptured and she has signs of internal bleeding, such as shock, low blood pressure, and an enlarging, painful belly. An exploratory laparotomy, which involves an incision in the abdomen, is done right away. Her shock is treated with fluids given through a vein, blood transfusion, and drugs to maintain blood pressure. Usually, blood clots have to be removed along with the affected tube.

What are the side effects of the treatments?
Side effects depend upon the treatment used. All surgery may result in:
  • bleeding
  • infection
  • rarely, death
Side effects of methotrexate include:
  • kidney failure
  • blood disorders
  • nerve damage
What happens after treatment for the condition?
How long a woman must be hospitalised depends on the treatment and the amount of blood loss. A woman should use birth control for at least 3 months after surgery to let her body recover and allow tissues to heal. She may wish to have a follow-up test to see if her tubes are open or blocked.

How is the condition monitored?
Between 10% to 20% of women treated for an ectopic pregnancy will have this occur again at a later date. If a woman who has had an ectopic pregnancy misses a period or notices symptoms of pregnancy, she should have a pregnancy test right away. If she is pregnant, she should get early antenatal care and have an ultrasound done to check the embryo's location.

Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

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