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Ectopic Pregnancy

An ectopic pregnancy is a fertilized egg that attaches in any area outside the lining of the uterus. The most common site is in the fallopian tubes. Other sites can include on the ovary, within the cervix and inside the abdomen. There is no way to save an ectopic pregnancy, so therapy needs to be considered as soon as it is diagnosed. If the pregnancy occurs in the fallopian tube it is referred to as a tubal pregnancy, in the abdomen as an abdominal pregnancy and in the ovary as an ovarian pregnancy. The growing placental tissue outside of the uterus will cause damage to the organs that it grows on and may even destroy the organs. The risk of having an ectopic pregnancy has been reported to be approximately one or two per 100 pregnancies.

What are the symptoms of an ectopic pregnancy?
Early in the pregnancy, many women may not be aware that they are pregnant and may not have symptoms. If symptoms occur, the symptoms may be the same as any women who is pregnant with breast tenderness, nausea and tiredness. The earliest symptoms of an ectopic may include vaginal bleeding, lower abdominal pain or cramping on one side of the pelvis. If the fallopian tube ruptures, symptoms may include sharp, doubling over pain in the lower abdomen, pain into the shoulder or neck, dizziness and lightheadedness or heavy vaginal bleeding.

What are the causes of ectopic pregnancy?
There is no specific cause that has ever explained why an ectopic pregnancy occurs, but certain things may increase the risk of having an ectopic pregnancy:

  • Previous ectopic pregnancy If a woman has experienced a previous ectopic pregnancy, she may be twice as likely to have another ectopic pregnancy.
  • Infections or inflammation of the fallopian tubes This is the most common factor that may increase risk. Gonorrhea or Chlamydia infections may increase the risk by creating an inflammation of the cervix, uterus or fallopian tubes. Endometriosis can also produce a chronic inflammation of the fallopian tubes.
  • Structural problems A fallopian tube may have developed abnormally or may have been damaged after surgery. Surgeries to repair the tubes may constrict the passage of the fallopian tubes and lead to risk of tubal pregnancies.
  • Infertility Medications to stimulate ovulation have been known to increase risk slightly.
  • Contraception An increased risk has been reported with usage of a birth control method, especially with IUD. A pregnancy that occurs after a tubal ligation is more likely to be ectopic.

When an ectopic pregnancy is diagnosed, the stakes are high. Treatment may include removal of a fallopian tube or an ovary, which might increase the risk of future infertility. If it is not treated, the ruptured fallopian tube can lead to life-threatening bleeding.

How is an ectopic pregnancy diagnosed?
The following modalities can be used to help diagnose an ectopic pregnancy:

  • Pregnancy test When a woman has bleeding and pain, she must first be sure that she is pregnant.
  • Physical exam This can be helpful in diagnosis but is not completely able to diagnose an ectopic pregnancy.
  • Lab studies Check for anemia.
  • Ultrasound Determine if the pregnancy is inside or outside the uterus. Sometimes symptoms occur earlier than ultrasound can diagnose the condition. So serial studies may need to be done. Usually the ectopic can be diagnosed by six to eight weeks after the last menstrual period.

What therapies are available for an ectopic pregnancy?

  • If an ectopic is diagnosed early enough, a medication call methotrexate can be injected to stop the growth and dissolve the existing cells of the pregnancy. After the injection, blood tests have to be monitored to make sure that the medication has worked.
  • Surgery Removal of the tissue from the tube or removal of the tube may have to be done. This may be done by laparoscopy or laparotomy (an abdominal incision).

Ectopic pregnancies can not be prevented. The limiting of sexual partners and use of condoms can decrease the risk of pelvic infections that might increase risk. Women who have an ectopic pregnancy can carry other healthy pregnancies but may have to be monitored closely in the early phase of the pregnancy. If an ectopic pregnancy occurs, it can be devastating due to the loss of pregnancy and the person will have a grief process to endure. Support groups and counseling are available for any pregnancy loss.

More about Dr. Aulds

Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.

Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.

Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.