Overview
In the case of ectopic pregnancies, the fertilized egg attaches to the wrong part of the reproductive tract and develops as a tumor. Ectopic pregnancies occur at any gestational age and can be diagnosed by ultrasound, laparoscopy, ultrasound during intrauterine gestation, or, in patients over 20 years of age, at at least 13 weeks gestation.
Ectopic pregnancies are not common, but they do occur. In the United States, ectopic pregnancies occur in approximately 2 percent of all women, and 1 percent of pregnancies. Ectopic pregnancies can occur in the fallopian tubes, but can also develop in the ovaries or uterus.
Causes of Ectopic Pregnancy
The cause of ectopic pregnancy is unknown. In women who have had a tubal ligation or who have gone through tubal reinsertion surgery, the most common cause of ectopic pregnancy is damage to the Fallopian tube during removal of the tube.
Some of the causes of ectopic pregnancy are quite serious, but other conditions can also lead to it.
Ectopic pregnancies occur when a fertilized egg attaches itself to the lining of the womb and cannot be transferred to the uterus, or it fails to implant in the uterus.
Symptoms of Ectopic Pregnancy
Ectopic pregnancies do not typically cause symptoms in the early stages.
When symptoms do appear, they tend to develop gradually and are not usually associated with the pregnancy. The first symptom to be noticed is vaginal bleeding, or menstrual bleeding that is usually heavy or prolonged.
If this is the first sign of an ectopic pregnancy, it may be mistaken for premenstrual bleeding.
Ectopic pregnancy symptoms typically appear within the first few weeks of pregnancy. Most women will experience vaginal bleeding, or heavy or prolonged vaginal bleeding.
Other symptoms include
- Urinary issues, such as frequent or severe discharge
- Pain or burning in the pelvis
- Gas or discomfort in the lower abdomen
- Pain or cramping in the back or upper back
- Backache
- Redness or swelling in the eyes
- Mild fever
- Weight loss and weight gain
In some women, symptoms are much more noticeable, such as long periods of vaginal bleeding, lasting between 4 and 12 weeks heavy menstrual bleeding, or dysmenorrhea, with symptoms ranging from bloating to fatigue to severe cramps pain when walking, lifting, or twisting the abdomen, back pain, swelling in the ankles or feet, loss of appetite or an unusual change in food preference.
Some women also experience nausea, vomiting, or diarrhea.
Genetic disorders, such as polycystic ovary syndrome (PCOS) or a disease known as tuberous sclerosis.
Infections, including human papillomavirus (HPV), or herpes simplex virus type 1 (HSV-1).
The underlying cause can also be a malfunctioning or damaged Fallopian tube or cervix, and some cases may be caused by miscarriage or tubal infertility.
Signs and symptoms
Any type of vaginal bleeding, whether due to menstruation or not, should be evaluated.
The most common symptoms of ectopic pregnancy are:
- Vaginal bleeding
- Pain during sex
- Pain with sexual intercourse
- Pain in the lower abdomen
- Back pain
Frequency and duration of symptoms varies depending on where the ectopic pregnancy is located. The majority of ectopic pregnancies occur in the Fallopian tube and usually within the first few weeks of pregnancy. The duration of symptoms may be reduced with medication. Ectopic pregnancy symptoms are not always caused by the presence of a Fallopian tube. Some of the following symptoms may indicate the presence of a pregnancy in the uterus:
- Maternity bleeding
- Painful intercourse
- Nausea and vomiting
- Pain during urination
- Weight loss
Pregnancy symptoms
Miscarriage may cause the symptoms of an ectopic pregnancy, and the two can be confused.
Most people experience symptoms of an ectopic pregnancy, such as a menstrual period and pain during sex, after they become pregnant. Most people do not experience symptoms until they are about 8 weeks into their pregnancy.
The cervix and Fallopian tube do not normally release a period when they are empty, but some women may experience bleeding between menstruation cycles.
Warning signs that indicate an ectopic pregnancy
- Pain during intercourse
- Pain during menstruation
- Pain with intercourse
- Nausea and vomiting
- Weight loss
- Excessive bruising
How to spot an ectopic pregnancy
An ectopic pregnancy is only present in the uterus or Fallopian tube. Most ectopic pregnancies do not show any signs or symptoms.
However, if the Fallopian tube is ruptured, the fetus may rupture, and the symptoms may appear soon after.
A ruptured ectopic pregnancy will show two red spots, called a “Fallopian tube nodule.” These spots are only visible with an ultrasound or during surgery. If the Fallopian tube is not ruptured, a ruptured ectopic pregnancy may produce vaginal bleeding and pain.
If an ectopic pregnancy is internal, a person can treat it with medications. This treatment will usually save the life of the fetus, but it may also end the life of the woman, as the death of a child may cause a miscarriage.
If someone suspects that they may be experiencing an ectopic pregnancy, they should seek emergency medical care immediately.
Who is at risk?
An ectopic pregnancy can occur at any time in a woman’s life, but it is more common during the perimenopause or menopause.
Ectopic pregnancy is much more common during pregnancy than it is in the general population, and up to a third of all ectopic pregnancies occur in pregnancy. If a person has an ectopic pregnancy while taking birth control, they should contact a doctor.
A person’s risk of ectopic pregnancy increases if they have a personal or family history of the disorder.
Risk factors
A pregnant woman with an ectopic pregnancy may develop an allergic reaction to antibiotics.
Although the odds of having an ectopic pregnancy increase with age, the risk remains low, particularly in younger women.
Ectopic pregnancies are not the result of poor nutritional habits or lack of exercise. A person’s chances of an ectopic pregnancy increase when they become more susceptible to infections.
Taking birth control pills for long periods of time, or having the pill inserted early in pregnancy, can increase the risk of ectopic pregnancy. A doctor may recommend going off the birth control pill and switching to an IUD to decrease the risk of ectopic pregnancy.
Other risks include
There is a risk of ectopic pregnancy if a person has a history of ectopic pregnancy or kidney disease. Another condition that can lead to ectopic pregnancy is tubal ligation. Doctors may prescribe an ultrasound scan for patients who have a history of tubal ligation. Normally, the embryo implants into the Fallopian tube.
When this is damaged, a blood clot forms and collects inside the tube.
When this clot breaks loose and travels to the uterus, there is a high risk of miscarriage. Women who have suffered miscarriages can have scar tissue build up in their Fallopian tubes.
If the Fallopian tube ruptures, then the sac of tissue around the embryo can escape and travel to the uterus, where it can potentially cause a miscarriage.
Normally, ectopic pregnancies last about seven to ten days.
If the woman is diagnosed and receives treatment, most women can expect a full recovery.
The risk of ectopic pregnancy varies widely. Women who have had a history of miscarriage have a greater chance of an ectopic pregnancy. If an ectopic pregnancy occurs after the woman has already had a previous ectopic pregnancy, there is a much higher chance of death from the subsequent ectopic pregnancy.
Symptoms of ectopic pregnancy
Symptoms include intense abdominal pain, nausea, vomiting, and fever.
Emergency room physicians may use ultrasound to diagnose ectopic pregnancy.
During pregnancy, the embryo develops into the baby and a gestational sac forms around the fetus. During an ectopic pregnancy, this sac develops outside the uterus and grows inside the Fallopian tube.
The sac of ectopic tissue can grow to two to five centimeters in diameter, and the embryo grows in the sac. During an ectopic pregnancy, the surrounding tissues begin to die due to the lack of oxygen and nutrients.
Diagnosis for ectopic pregnancy
If your doctor suspects an ectopic pregnancy, he or she may:
Take ultrasound images of the sac. These images can show the presence of an ectopic pregnancy in the Fallopian tube or in the ovary. A doctor or technician should use a trans-vaginal ultrasound probe to get the images.
These images can show the presence of an ectopic pregnancy in the Fallopian tube or in the ovary. Place a stick-on speculum to dilate your cervix. Then, the doctor may perform a small incision to obtain a sample of the tissue. He/she then Inserts an ultrasound probe to perform a fetal blood test. This test is more accurate than the preliminary pregnancy test. It looks for the level of hCG hormone, which is produced when a fertilized egg implants in the uterus.
Treatment for ectopic pregnancy
An ectopic pregnancy can be treated by immediate medical treatment.
Heparin, a blood thinner, may be used to treat an ectopic pregnancy that has not ruptured. Ectopic pregnancy (aborted) about a month earlier can also be treated with low doses of clomifene.
Blood thinners are not recommended for older women with a previous ectopic pregnancy, as they can increase the chance of hemorrhage. Surgery is also required if the uterus or Fallopian tube are damaged by the pregnancy or the the embryo has died.
If bleeding continues, emergency surgery may be required. Outcome of an ectopic pregnancy varies. The rate of successful pregnancy varies according to various factors. Some women will be able to get pregnant within one to two months after an ectopic pregnancy.
Birth rate for ectopic pregnancy
For those who survive, a chance of future pregnancies is low.
A 30% chance of another ectopic pregnancy within two years is a reasonable expectation. Recent evidence shows that most ectopic pregnancies were ectopic in the first place, but a minority went on to become blastocyst-stage pregnancies.
Outcomes depend on the cause and the severity of the pregnancy. For women who have previously had an ectopic pregnancy, the chances of another ectopic are likely to be extremely low, as no one experiences an ectopic only once.
It can happen at any point in the reproductive cycle but is most common in the second trimester. Most pregnancies ectopic (as defined by the World Health Organization) occur in the Fallopian tube.
In 2007, around 2 million pregnancies were ectopic in the UK. There is an 11% chance of another ectopic within four years.
Around 1 in 2000 pregnancies end in ectopic every year in the UK and 1 in 25 in the US. With treatment, a 10% chance of another ectopic pregnancy within four years is possible. Some women with a single ectopic have a subsequent pregnancy within 4 weeks. Outcome depends on the severity of the original ectopic.
Research results of ectopic pregnancy
A 2015 review states that “it is unclear whether pregnancy ectopically lost can be reproduced”. In 1992 the World Health Organization (WHO) recommended that hospitals in low- and middle-income countries improve care for ectopic pregnancies and that standards of care in high-income countries must be improved.
The studies cited in the WHO review show that about 40–60% of ectopic pregnancies have no further complications, while 50–90% have some complications. Ectopic pregnancy termination rates in developing countries are as low as 0.1%, while in the developed world about 90–95% of ectopic pregnancies are terminated.
The size of the developing ectopic may be measured using trans-vaginal sonography or intrauterine pregnancy measurements.
Three broad groups of ectopic pregnancies can be distinguished
For ectopic abortion, the technique involves the expulsion of the developing fetus via the forceps or similar instruments.
Most often the anterior vaginal wall is used to guide the technique. The procedure can be performed by qualified personnel using an ultrasound or laparoscope. A single dose of local anesthetic and analgesics is given to achieve control of pain. Operating theaters may be equipped with specialized equipment such as ‘utility’ forceps, and special sutures for guiding the fetus out.
Intravenous drugs such as methotrexate, leuprolide and nifedipine are sometimes used to induce complete expulsion.
Surgery may be performed as a stand-alone procedure, with further management after the procedure. In the most common procedure, the fetus is extracted from the wall and passed out through the vagina. The membrane of the implanted tubal pregnancy is then separated from the spermatic cord.
The tissue is then stitched up, and there is no need to remove or repair the uterus.
Bottom Line
If you do have another ectopic pregnancy in the future, it will be more likely to happen if you’ve already had a successful pregnancy. This is because your body might have developed a resistance to taking the medicine that prevents further ectopic pregnancies. It’s also more likely to happen if you have a history of complications with other pregnancies.
Sirisha B