ECTOPIC PREGNANCY

DEFINITION• Pregnancy begins with a fertilized egg. Normally, the fertilized egg

attaches itself to the lining of the uterus. With an ectopic pregnancy, the fertilized egg implants somewhere outside the uterus.

• An ectopic pregnancy typically occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or cervix.

• It is life-threatening to the mother

LOCATIONS OF ECTOPIC PREGNANCIES

LOCATIONS OF ECTOPIC PREGNANCIES

75-90%

5-15%

5%

1-2%

SYMPTOMSAt first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy — missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal.

Abdominal or pelvic pain and light vaginal bleeding are often the first warning signs of an ectopic pregnancy. If blood leaks from the fallopian tube, it's also possible to feel shoulder pain or an urge to have a bowel movement — depending on where the blood pools or which nerves are irritated. Heavy vaginal bleeding is unlikely, unless the ectopic pregnancy occurs in the cervix.

SYMPTOMS• Low back pain

• Mild cramping on one side of the pelvis

• No periods

• Pain in the lower belly or pelvic area

• Abnormal vaginal bleeding

If the area around the abnormal pregnancy ruptures:

• Fainting or feel faint

• Intense pressure in the rectum

• Low blood pressure

• Severe, sharp, and sudden pain in the lower abdomen

CAUSES/RISK FACTORSThe main cause of an ectopic pregnancy is a damaged fallopian tube that doesn't let a fertilized egg into your uterus, so it implants in the fallopian tube or somewhere else. You might never know what caused an ectopic pregnancy, but you are at a higher risk if you have:

• History of an ectopic pregnancy

• Use of an IUD

• History of pelvic inflammatory disease (PID)

• Sexually-transmitted diseases such as chlamydia and gonorrhea / multiple sexual partners

• Congenital abnormality of the fallopian tube

• History of pelvic surgery (because scarring may block the fertilized egg from leaving the fallopian tube)

• Tubal ligation, unsuccessful tubal ligation or tubal ligation reversal

• Use of fertility drugs

• Infertility treatments such as in vitro fertilization (IVF)

• Conditions such as endometriosis and fibroids can narrow the fallopian tubes

• Smoking (dose-dependent) around the time of conception

TESTS & DIAGNOSIS• Pelvic Exam – May show tenderness in the pelvic area

• Transvaginal Ultrasound

• Blood Test - Beta hCG

TREATMENTTreatment options for ectopic pregnancy include observation, laparoscopy, laparotomy, and medication. Selection of these options is individualized. Some ectopic pregnancies will resolve on their own without the need for any intervention, while others will need urgent surgery due to life-threatening bleeding.

• Laparotomy / Laparoscopy

• Medication - Methotrexate

OUTLOOKMost women who have an ectopic pregnancy have normal pregnancies and births in the future, even if a fallopian tube was removed. As long as you have one normally working fallopian tube, you can get pregnant. If the ectopic pregnancy was caused by a treatable illness, such as a sexually transmitted disease, getting treated for it can improve your chances of a successful pregnancy. Talk with your doctor about how long to wait after an ectopic pregnancy before trying to conceive again. Some doctors suggest waiting 3 to 6 months.