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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
  • Scarring after a ruptured appendix
  • Endometriosis
  • 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.

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:

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

Alternative Names

Tubal pregnancy; Cervical pregnancy; Tubal ligation - ectopic pregnancy

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.

Update Date 4/5/2016

Updated 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.

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