Ectopic means "out of place." In an ectopic pregnancy,
a fertilized egg has implanted outside the
. The egg settles in the fallopian tubes in more than 95% of
ectopic pregnancies. 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 does not develop into a live birth.
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
The first warning signs of an ectopic pregnancy are often pain
or vaginal bleeding. 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 come and go or vary in
Any of the following additional symptoms can also suggest an
- vaginal spotting
- dizziness or fainting (caused by blood loss)
- low blood pressure (also caused by blood loss)
- lower back pain
What Causes an Ectopic Pregnancy?
An ectopic pregnancy results from a fertilized egg's
inability to work its way quickly enough down the fallopian tube
into the uterus. An infection or inflammation of the tube might
have partially or entirely blocked it.
Pelvic inflammatory disease (PID)
, which can be caused by gonorrhea or chlamydia, is a common
cause of blockage of the fallopian tube.
Endometriosis (when cells from the lining of the uterus implant
and grow elsewhere in the body) or scar tissue from previous
abdominal or fallopian surgeries can also cause blockages. More
rarely, birth defects or abnormal growths can alter the shape of
the tube and disrupt the egg's progress.
If you arrive in the emergency department complaining of
abdominal pain, you'll likely be given a urine pregnancy test.
Although these tests aren't sophisticated, they are fast - and
speed can be crucial in treating ectopic pregnancy.
If you already know you're pregnant, or if the urine test
comes back positive, you'll probably be given a quantitative
hCG test. This blood test measures levels of the hormone
human chorionic gonadotropin
, which is produced by the placenta and appears in the blood and
urine as early as 8 to 10 days after conception. Its levels
double every 2 days for the first several weeks of pregnancy, so if
hCG levels are lower than expected for your stage of pregnancy, one
possible explanation might be an ectopic pregnancy.
You'll probably also get an ultrasound examination, which
can show whether the uterus contains a developing fetus or if
masses are present elsewhere in the abdominal area. But the
ultrasound might not be able to detect every ectopic pregnancy. The
doctor may also give you a pelvic exam to locate the areas causing
pain, to check for an enlarged, pregnant uterus, or to find any
Even with the best equipment, it's hard to see a pregnancy
less than 5 weeks after the last menstrual period. If your doctor
can't diagnose ectopic pregnancy but can't rule it out, he
or she may ask you to return every 2 or 3 days to measure your hCG
levels. If these levels don't rise as quickly as they should,
the doctor will continue to monitor you carefully until an
ultrasound can show where the pregnancy is.
Options for Treatment
Treatment of an ectopic pregnancy varies, depending on how
medically stable the woman is and the size and location of the
An early ectopic pregnancy can sometimes be treated with an
injection of methotrexate, which stops the growth of the
If the pregnancy is further along, you'll likely need
surgery to remove the abnormal pregnancy. In the past, this was a
major operation, requiring a large incision across the pelvic area.
This might still be necessary in cases of emergency or extensive
However, the pregnancy may sometimes be removed using
laparoscopy, a less invasive surgical procedure. The surgeon makes
small incisions in the lower abdomen and then inserts a tiny video
camera and instruments through these incisions. The image from the
camera is shown on a screen in the operating room, allowing the
surgeon to see what's going on inside of your body without making
large incisions. The ectopic pregnancy is then surgically removed
and any damaged organs are repaired or removed.
Whatever your treatment, the doctor will want to see you
regularly afterward to make sure your hCG levels return to zero.
This may take several weeks. An elevated hCG could mean that some
ectopic tissue was missed. This tissue may have to be removed using
methotrexate or additional surgery.
What About Future Pregnancies?
Some women who have had ectopic pregnancies will have difficulty
becoming pregnant again. This difficulty is more common in women
who also had fertility problems before the ectopic pregnancy. Your
prognosis depends on your fertility before the ectopic pregnancy,
as well as the extent of the damage that was done.
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
Who's at Risk for an Ectopic Pregnancy?
While any woman can have an ectopic pregnancy, the risk is
highest for women who are over 35 and have had:
- a previous ectopic pregnancy
- surgery on a fallopian tube
- infertility problems or medication to stimulate
Some birth control methods can also affect your risk of ectopic
pregnancy. If you get pregnant while using progesterone-only oral
contraceptives, progesterone intrauterine devices (IUDs), or the
morning-after pill, you might be more likely to have an ectopic
pregnancy. Smoking and having multiple sexual partners also
increases the risk of an ectopic pregnancy.
When to Call Your Doctor
If you believe you're at risk for an ectopic pregnancy, meet
with your doctor to discuss your options before you become
pregnant. You can help protect yourself against a future ectopic
pregnancy by not smoking and by always using condoms when
you're having sex but not trying to get pregnant. Condoms can
protect against sexually transmitted infections (STDs) that can
If you are pregnant and have any concerns about the pregnancy
being ectopic, talk to your doctor - it's important to make
sure it's detected early. You and your doctor might want to
plan on checking your hormone levels or scheduling an early
ultrasound to ensure that your pregnancy is developing
Call your doctor
if you're pregnant and experiencing any pain, bleeding, or
other symptoms of ectopic pregnancy. When it comes to detecting an
ectopic pregnancy, the sooner it is found, the better.
Larissa Hirsch, MD
Date reviewed: February 2008
Serdar H. Ural, MD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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