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Ectopic pregnancy
Tubal pregnancy; Cervical pregnancy; Tubal ligation - ectopic pregnancy
An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother.
Causes
In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include:
- Birth defect in the fallopian tubes
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Scarring after a
ruptured appendix
Ruptured appendix
Appendicitis is swelling (inflammation) of the appendix. The appendix is a small pouch attached to the large intestine.
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Endometriosis
Endometriosis
Endometriosis occurs when cells from the lining of your womb (uterus) grow in other areas of your body. This can cause pain, heavy bleeding, bleedin...
ImageRead Article Now Book Mark Article - Having had an ectopic pregnancy in the past
- Scarring from past infections or surgery of the female organs
The following also increase risk of an ectopic pregnancy:
- Age over 35
- Getting pregnant while having an intrauterine device (IUD)
- Having your tubes tied. This is more likely 2 or more years after the procedure
- Having had surgery to untie tubes to become pregnant
- Having had many sexual partners
- Some infertility treatments
Sometimes, the cause is unknown. Hormones may play a role.
The most common site for an ectopic pregnancy is within 1 of the 2 fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix .
Cervix
The cervix is the lower end of the womb (uterus). It is at the top of the vagina. It is about 2 inches (5 centimeters) long. The cervical canal pa...
An ectopic pregnancy can occur even if you use birth control.
Symptoms
You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include:
- Abnormal vaginal bleeding
- Low back pain
- Mild cramping on one side of the pelvis
- No periods
- Pain in the lower belly or pelvic area
If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:
- Fainting or feeling faint
- Intense pressure in the rectum
- Low blood pressure
- Pain in the shoulder area
- Severe, sharp, and sudden pain in the lower abdomen
Exams and Tests
The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area.
A pregnancy test and vaginal ultrasound will be done.
HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your provider may suspect an ectopic pregnancy.
Treatment
Ectopic pregnancy is life threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life.
If the ectopic pregnancy has not ruptured, treatment may include:
-
Surgery
Surgery
Pelvic laparoscopy is surgery to examine pelvic organs. It uses a viewing tool called a laparoscope. The surgery is also used to treat certain dise...
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You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include:
- Blood transfusion
- Fluids given through a vein
- Keeping warm
- Oxygen
- Raising the legs
If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube.
Outlook (Prognosis)
One out of three women who have had 1 ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again.
The likelihood of a successful pregnancy after an ectopic pregnancy depends on:
- The woman's age
- Whether she has already had children
- Why the first ectopic pregnancy occurred
When to Contact a Medical Professional
Call your provider if you have:
- Abnormal vaginal bleeding
- Lower abdominal or pelvic pain
Prevention
Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include:
- Practicing safer sex by taking steps before and during sex, which can prevent you from getting an infection
- Getting early diagnosis and treatment of all infections caused by sexual relations (STDs)
- Stopping smoking
References
American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 94: Medical management of ectopic pregnancy. Obstet Gynecol . 2008;111(6):1479-1485. PMID: 18515537 www.ncbi.nlm.nih.gov/pubmed/18515537 .
Houry DE, Salhi BA. Acute complications of pregnancy. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice . 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 178.
Lobo RA. Ectopic pregnancy: etiology, pathology, diagnosis, management, fertility prognosis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology . 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 17.
Nelson AL, Gambone JC. Ectopic pregnancy. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2016:chap 24.
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Pelvic laparoscopy - illustration
Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.
Pelvic laparoscopy
illustration
-
Ultrasound in pregnancy - illustration
The ultrasound has become a standard procedure used during pregnancy. It can demonstrate fetal growth and can detect increasing numbers of conditions in the fetus including meningomyelocele, congenital heart disease, kidney abnormalities, hydrocephalus, anencephaly, club feet, and other deformities. Ultrasound does not produce ionizing radiation and is considered a very safe procedure for both the mother and the fetus.
Ultrasound in pregnancy
illustration
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Female reproductive anatomy - illustration
External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.
Female reproductive anatomy
illustration
-
Uterus - illustration
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Uterus
illustration
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Ultrasound, normal fetus - foot - illustration
This is a normal ultrasound of a fetus at 19 weeks gestation. The right foot, including the developing bones, are clearly visible in the middle of the screen.
Ultrasound, normal fetus - foot
illustration
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Ectopic pregnancy - illustration
An ectopic pregnancy is one in which the fertilized egg implants in tissue outside of the uterus and the placenta and fetus begin to develop there. The most common site is within a Fallopian tube, however, ectopic pregnancies can occur in the ovary, the abdomen, and in the lower portion of the uterus (the cervix).
Ectopic pregnancy
illustration
-
Pelvic laparoscopy - illustration
Laparoscopy is performed when less-invasive surgery is desired. It is also called Band-Aid surgery because only small incisions need to be made to accommodate the small surgical instruments that are used to view the abdominal contents and perform the surgery.
Pelvic laparoscopy
illustration
-
Ultrasound in pregnancy - illustration
The ultrasound has become a standard procedure used during pregnancy. It can demonstrate fetal growth and can detect increasing numbers of conditions in the fetus including meningomyelocele, congenital heart disease, kidney abnormalities, hydrocephalus, anencephaly, club feet, and other deformities. Ultrasound does not produce ionizing radiation and is considered a very safe procedure for both the mother and the fetus.
Ultrasound in pregnancy
illustration
-
Female reproductive anatomy - illustration
External structures of the female reproductive anatomy include the labium minora and majora, the vagina and the clitoris. Internal structures include the uterus, ovaries and cervix.
Female reproductive anatomy
illustration
-
Uterus - illustration
The uterus is a hollow muscular organ located in the female pelvis between the bladder and rectum. The ovaries produce the eggs that travel through the fallopian tubes. Once the egg has left the ovary it can be fertilized and implant itself in the lining of the uterus. The main function of the uterus is to nourish the developing fetus prior to birth.
Uterus
illustration
-
Ultrasound, normal fetus - foot - illustration
This is a normal ultrasound of a fetus at 19 weeks gestation. The right foot, including the developing bones, are clearly visible in the middle of the screen.
Ultrasound, normal fetus - foot
illustration
-
Ectopic pregnancy - illustration
An ectopic pregnancy is one in which the fertilized egg implants in tissue outside of the uterus and the placenta and fetus begin to develop there. The most common site is within a Fallopian tube, however, ectopic pregnancies can occur in the ovary, the abdomen, and in the lower portion of the uterus (the cervix).
Ectopic pregnancy
illustration
Review Date: 4/5/2016
Reviewed By: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
