What is ectopic pregnancy?
Ectopic pregnancy is any pregnancy in which the embryo has implanted outside of the uterine cavity, which means not in the endometrium, the layer of tissue that covers the inside of the uterus. Ninety-five percent of ectopic pregnancies occur in a fallopian tube, usually in a part of the tube called the ampulla, the part of the tube that curves over the ovary. In such cases, the term tubal pregnancy also describes the condition. Ectopic pregnancy also can occur in other places, including the ovary, the cervix, the myometrium (muscular layer of the uterus), completely outside the uterus and tubes in the abdominal cavity, and in a surgical scar, such as the uterine wall or abdominal wall resulting from a cesarean section. This is a dangerous situation that threatens the mothers life as the embryo grows.
How common is ectopic pregnancy?
Ectopic pregnancy accounts for approximately 20 out of every 1,000 pregnancies. As noted earlier, 95 percent of these ectopic pregnancies are tubal pregnancies. Factors that increase your chances of suffering an ectopic pregnancy include a previous ectopic pregnancy, pelvic inflammatory disease, infertility, fertility treatment, smoking, surgery on the tubes, endometriosis, anatomical abnormalities (such as a double uterus), and exposure to diethylstilbestrol (DES) when your mother was pregnant with you. A synthetic hormone, DES was given to some pregnant women in the period from 1940 to 1971. When it comes to having a history of ectopic pregnancy, this is a particularly strong risk factor. If you have had one ectopic pregnancy treated with a procedure called linear salpingostomy, your chance of having an ectopic pregnancy the next time ranges from 15 to 20 percent. The risk increases further as the number of past ectopic pregnancies rises, although if you achieve a normal pregnancy after a series of ectopic pregnancies then your risk starts to go down.
How is ectopic pregnancy diagnosed?
After symptoms, such as severe abdominal pain and vaginal bleeding, alert you and your doctor that something is wrong, you will be given a pregnancy test to detect the hormone beta-human chorionic gonadotropin (beta-HCG) in your urine and then to measure the concentration of beta-HCG in your blood. You will also be tested by ultrasonography to look for a gestational sac in your uterus and a mass in your fallopian tubes. If no gestational sac is visible in your uterus, or if your beta-HCG level is below 1500 mIU/mL, you will be tested with a series of beta-HCG blood tests to see if the beta-HCG level is roughly doubling every 48 as it should in a normal pregnancy. If the beta-HCG level is not increasing very much, this means that it is not a healthy pregnancy and that it could be ectopic. More ultrasonography will be conducted to see if a mass appears in a fallopian tube. If this doesnt happen, your obstetrician will look for evidence of ectopic pregnancy in less common locations. Along the way, particularly if there is little or no vaginal bleeding, you will also be checked for other abdominal emergencies, such as acute appendicitis and acute cholecystitis. You also will be evaluated for other conditions that potentially could confuse the situation, such as familial Mediterranean fever. More than 85 percent of cases diagnosed before the tube ruptures and early diagnosis often allows for tubes to be preserved so that the woman can attempt pregnancy again.
Does ectopic pregnancy cause problems?
Yes. If not recognized and monitored closely or treated, ectopic pregnancy can lead to tubal rupture, resulting in hemorrhage, causing hypovolemic shock (a sudden drop in blood pressure, threatening life, due to loss of blood). The rupture also can lead to infection within the tube and/or the abdominal-pelvic cavity, which also threatens life. Thus, ectopic pregnancy accounts for 4 to 10 percent of pregnancy deaths.
Does ectopic pregnancy cause problems for the baby?
At the present state of medical capability, there is no means of transferring an ectopically implanted embryo into a place where it can thrive. Furthermore, in nearly all cases, an ectopic pregnancy is not discovered until after the embryo is no longer viable. The fact that the beta-HCG concentration is not rising in the mothers blood at a rate consistent with healthy development means that there has never been a justification for developing surgical procedures for relocating an ectopic embryo to a place where it can survive, such as the mothers uterus. The same rational likely will apply to artificial womb devices that may become available in the decades to come. If you do suffer an ectopic pregnancy, you need to get into the mindset that there is no baby, as there is no way to make the pregnancy viable.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself, if you do not treat the ectopic pregnancy
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat ectopic during pregnancy?
Medical treatment for ectopic pregnancy consists of chemical agents that will terminate the pregnancy by destroying the embryo, the main one being methotrexate. Although this is a fairly toxic drug that notoriously produces nausea and vomiting and often diarrhea, for ectopic pregnancy, it is given in relatively low doses and not for very long. This type of treatment is appropriate when the ectopic pregnancy is discovered fairly early before there is an abdominal emergency, in which case surgical treatment is needed.
Who should NOT stop taking medication for ectopic pregnancy?
Medical treatment, such as methotrexate, is given to you while you are under direct supervision in an emergency setting, usually the delivery room, so it is not a long term treatment that you can decide to stop.
What should I know about choosing a medication for my ectopic pregnancy?
It is important to stay in communication with your health care provider as the release of new studies over time can change the outlook on the role of specific medications during pregnancy.
You may find Pregistrys expert reports about the medications to treat this condition here. Additional information can also be found in the sources listed below.
What should I know about taking a medication for my ectopic pregnancy when I am breastfeeding?
If you suffer an ectopic pregnancy, there will be no baby, so you will not be breastfeeding.
What alternative therapies besides medications can I use to treat my ectopic pregnancy?
When an ectopic pregnancy is discovered early, it can be handled through whats called expectant management, sometimes called watchful waiting. This means that you are admitted to the hospital, where doctors monitor you closely to see if your ectopic pregnancy aborts spontaneously and if everything comes out without damage to a fallopian tube, ovary, or other structure. During the monitoring period, doctors also are looking for signs that your condition is worsening to the point that you
will need medical or surgical treatment. Various studies suggest that more than two-thirds of ectopic pregnancies resolve without treatment. Surgical treatment can be either salpingectomy (removal of the fallopian tube) or salpingostomy (clearing out the tube without removing the tube). Either of these operations can be performed as an open procedure (laparotomy, meaning through an abdominal incision) or laparoscopically (with instruments through tubes inserted through very small incisions).
What can I do for myself when I have an ectopic pregnancy?
It is very important to follow the instructions of your physician.
Resources for ectopic pregnancy:
For more information about ectopic pregnancy during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations: