Ectopic Pregnancy

An ectopic pregnancy occurs when the fertilized egg implants in the fallopian tubes instead of the uterus. (Though this is the most common locale, the fertilized egg can also implant in the ovary, abdomen, or cervix.) A pregnancy that implants in one of these areas cannot grow to term. The uterus is the only place a pregnancy can grow properly. If an ectopic pregnancy continues, it will cause the tube to burst. This can cause bleeding and endanger the mother's life, which is why an ectopic pregnancy is of great concern.

Causes of Ectopic Pregnancies

The risk of ectopic pregnancy increases as a woman ages, and women over age 35 have a risk that is three to four times higher than that of younger women. Some physicians believe that as a woman ages, the myoelectrical activity (the nerve activity that stimulates the fine hairs, called cilia, in the tubes to gently move the egg along) in her tubes decreases. When this movement slows down, it makes it more likely a fertilized egg won't be moved quickly enough to the uterus and will instead implant in the tube itself.

Ectopic pregnancies also often occur if there is blockage or inflammation in the tubes (more likely as a woman ages), making it difficult for the egg to travel through them. The risk of ectopic pregnancy is highest in women who have had PID (pelvic inflammatory disease), infertility, luteal phase defect, previous ectopic pregnancies, pelvic surgery, surgery involving a fallopian tube, or who have taken fertility drugs. An ectopic pregnancy is four times more likely when fertility drugs are used.

A study in the British Medical Journal found that by the time women reach age 35, one in five pregnancies ends in miscarriage, stillbirth, or ectopic pregnancy. While this number might seem high, remember that four out of five pregnancies have happy endings.

If a woman's mother took the drug diethylstilbestrol (DES, used for miscarriage prevention up until 1971) when pregnant with her this is another risk factor. Congenital malformations of the uterus, fibroids near the tubal insertion into the uterus, hormonal fluctuations found in older women, smoking, and vaginal douching have also been indicated as possible risk factors for ectopic pregnancies. A chromosomally abnormal embryo is also more likely to implant in the tubes than in the uterus.

If a woman becomes pregnant while she has an IUD, it is more likely the pregnancy will implant in the tubes. Progesterone IUDs and progesterone-only contraceptive pills may increase the risk of ectopic pregnancies, since the progesterone affects tubal functioning.

Of women who have had an ectopic pregnancy, 30 percent have difficulty getting pregnant again, but 70 percent do not and are able to have successful pregnancies. If you go on to get pregnant again after an ectopic pregnancy, you may be very nervous about having another ectopic pregnancy, but an early ultrasound can ease your worries.

Stopping smoking and removing a progesterone IUD can decrease the risk of ectopic pregnancy. Other than this, though, there is nothing you can do to prevent ectopic pregnancy. If you are at high risk, you will be monitored more closely at the beginning of your pregnancy. If you are seeing a fertility specialist, it is likely your pregnancy will be monitored by ultrasound from the very beginning to rule out an ectopic pregnancy.

Signs of an Ectopic Pregnancy

An ectopic pregnancy can be difficult to identify because the beginning symptoms are the same as for a normal pregnancy (missed period, nausea, painful breasts). The biggest red flag for an ectopic pregnancy is abdominal pain, which is not normal for a healthy pregnancy. The pain is often focused on one side, but it can occur anywhere in the abdomen or even up to the shoulders if blood builds up.

Other symptoms include the following:

  • Dizziness

  • Vaginal spotting or bleeding

  • Fainting

  • Low blood pressure

  • Pain in the lower back or shoulder

If you experience any of these symptoms, you need to contact your physician immediately, but don't panic. More often than not, even with the symptoms listed above, a normal pregnancy is occurring. All of the symptoms above can occur in a normal pregnancy. Frequently, the ovary from which you ovulated (the corpus luteum) can enlarge, become tender and even bleed a bit. However, you should always report any symptoms to a physician.

If an ectopic pregnancy is suspected, your physician will do a pelvic exam and ultrasound to determine if there is implantation in the tubes. Your pregnancy hormones may be tested; a lower-than-normal level can also confirm an ectopic pregnancy.

If you already have risk factors for an ectopic pregnancy, it is even more important to seek immediate medical attention. In patients known to be at high risk for an ectopic pregnancy, the physician will generally not wait for symptoms but will follow HCG levels and do ultrasounds.

Treatment

An ectopic pregnancy cannot be moved to the uterus, as there is no way to move the embryo once it is implanted, nor can it be removed and frozen. Only unimplanted embryos created during fertility procedures can be cryopreserved in this way. If the mother's HCG level (pregnancy hormone) is low, she has no symptoms, and the HCG levels continue to decline, no treatment may be necessary. A large percentage of ectopic pregnancies end on their own without treatment.

If the mother has no symptoms and is stable, but the size of the pregnancy, presence of a live embryo, and high HCG levels are of concern, medical treatment with methotrexate injection to medically end the pregnancy and have the mother's body expel it is an option.

In other cases, surgery is necessary to remove the implanted fertilized egg. In many cases, this can be done by laparoscopy, a minimally invasive procedure done as an outpatient procedure. Often the ectopic pregnancy can be removed from the tube, leaving the tube intact. However, this is not always possible. In most cases, the tubes remain healthy after an ectopic pregnancy, but in some cases, scarring may result and the tube might not be functional again.

While there is no chance of ectopic pregnancy surviving, that does not mean that the end of the pregnancy is not a loss. Losing an ectopic pregnancy is just as devastating as any other type of pregnancy loss, and you must take time to grieve for it. And because a woman who experiences an ectopic pregnancy may have surgery, the physical recovery period may be longer than with a miscarriage. The stress involved in an ectopic pregnancy is also great. It is a dangerous condition and one that must be treated immediately, so in addition to the grief over losing a pregnancy, there is also emotional recovery from the stress and urgency of the situation.

It is important to remember that if you have had a previous ectopic pregnancy, your chances of having another ectopic pregnancy increase significantly. This makes it important to see your doctor very early in any subsequent pregnancies.

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