ECTOPIC PREGNANCY

 Basic information

description

An ectopic pregnancy is one that develops outside the uterus. The most common site is in one of the narrow fallopian tubes that connect each ovary to the uterus. Other sites include the ovary or outside the reproductive organs in the abdominal cavity or the cervix. About 1% to 2% of pregnancies are ectopic.

FREQUENT SIGNS & SYMPTOMS

• Early stages:
  • Missed or late menstrual period.
  • Vaginal spotting or bleeding.
  • Pain and cramps in the lower abdomen.
  • Pain in the shoulder (rare).
• Late stages:
  • Sudden, sharp, severe pain in the abdomen.
  • Dizziness, fainting, and shock (paleness, rapid heartbeat, drop in blood pressure, and cold sweats). These may occur before or along with the pain.

causes

An egg from the ovary is fertilized and becomes implanted outside the uterus. This usually occurs in a fallopian tube that has been damaged (resulting in blockage or narrowing). As the fertilized egg enlarges, the fallopian tube may stretch and rupture. This leads to life-threatening internal bleeding.

risk increases with

• Prior abdominal or pelvic infection.
• Pelvic inflammatory disease (PID).
• Pregnancy after a tubal ligation.
• Assisted reproduction techniques, such as in vitro fertilization.
• Adhesions (scar tissue) from prior abdominal surgery.
• Previous ectopic pregnancy.
• Previous tubal or uterine surgery.
• History of endometritis (inflammation of the endometrium, which is the lining of the uterus).
• Endometriosis (a disorder of the fallopian tube).
• Malformed (abnormal) uterus.
• Use of an intrauterine device (IUD) for contraception.
• Smoking.
• History of exposure to diethylstilbestrol (DES).
• Many women diagnosed with an ectopic pregnancy do not have a risk factor.

PREVENTIVE MEASURES

It cannot be prevented.

expected outcomes

An ectopic pregnancy is always going to be lost. It may resolve on its own before a period is missed. Rupture of an ectopic pregnancy is an emergency. Full recovery is likely with early diagnosis and treatment.

possible complications

• Internal bleeding that can be life-threatening.
• Reduced fertility.
• Repeat ectopic pregnancy.

 diagnosis & treatment

general measures

• Medical tests may include blood studies, ultrasound, laparoscopy (a telescope-like tool is used to look inside the abdomen), and other tests as needed.
• Diagnosis and treatment may be done on an outpatient basis. Hospital care may be needed for surgery and supportive care. A blood transfusion may be required.
• Before rupture of the tube, a diagnosed ectopic pregnancy may be treated using the laparoscope instrument, or with an injected drug.
• Surgery may be needed to remove the developing embryo, placenta, and any damaged tissue. The fallopian tube is removed if it cannot be repaired. Future pregnancy is possible with one fallopian tube.
• Weekly blood tests may be recommended to be sure treatment is successful. If persistent ectopic pregnancy is diagnosed, a drug may be prescribed for treatment.
• At home, use heat to relieve pain. Apply a heating pad to the abdomen or back. Warm baths help. Sit in a tub of warm water for 10 to 15 minutes. Repeat as needed.
• Counseling may help you with the emotional aspects.
• To learn more: www.ectopicpregnancy.org.

medications

• In some ectopic pregnancies, methotrexate may be prescribed for treatment. Specific guidelines and close follow-up care are needed when this drug is used.
• After surgery, pain relievers may be prescribed.

activity

Your health care provider will advise you when to resume normal activities, as well as sexual relations.

diet

No special diet.

 notify our office if

You or a family member has symptoms of ectopic pregnancy, especially a rupture (this is an emergency).

Special Notes: