Ask the DOC

By Peter Galvin, MD

Ectopic Pregnancy

An ectopic pregnancy occurs when a pregnancy develops outside of the uterus. As you probably know, normal female reproductive anatomy includes two ovaries, one on each side, two fallopian tubes that connect the ovaries to the uterus, and the uterus itself. An ectopic pregnancy is usually diagnosed during the first trimester of pregnancy (there are three trimesters, each lasting about three months). An ectopic pregnancy cannot develop normally to term and may be life-threatening to the mother. Most ectopics are in the fallopian tubes, however rarely an ectopic can occur in the ovary or within the abdomen. As an ectopic progresses, it can cause the fallopian tube to burst (rupture), resulting in bleeding within the abdomen. A ruptured ectopic pregnancy can result in the death of the mother if she does not receive urgent medical evaluation and surgical intervention.

About 2% of all pregnancies are ectopic. Although most women with ectopic pregnancies do not have any clear risk factors, women with a history of pelvic inflammatory disease, endometriosis, and prior ectopic pregnancy or fallopian tube surgery are at increased risk. Other factors that may increase the likelihood of ectopic pregnancy include being older than 35 years, cigarette smoking, history of infertility, and use of fertility treatment, such as in vitro fertilization. The most common symptoms of ectopic pregnancy are vaginal bleeding and abdominal and/or pelvic pain that is worse than menstrual cramps. However, early ectopic pregnancy may be asymptomatic.

Diagnosing an ectopic pregnancy includes blood levels of human chorionic gonadotropin (hCG) and transvaginal ultrasound. An ectopic may be suspected when elevated levels of hCG are detected but the ultrasound fails to detect a pregnancy in the uterus. Sometimes, ultrasound may detect an ectopic in the fallopian tube. An ectopic may also be suspected when levels of hCG do not rise as expected or actually decrease. Because ectopic pregnancy can be life-threatening, women are treated as quickly as possible with either medication or surgery, regardless of the presence of a fetal heartbeat. Rarely, an ectopic will resolve without any intervention under close medical observation.

Some early ectopics may be treated with one or more injections of methotrexate. Resolution of the ectopic in this scenario takes about 6 weeks and requires monitoring of hCG levels and physician follow-up. Unruptured ectopics may be treated with minimally invasive surgery (laparoscopy) or, rarely, open abdominal surgery (laparotomy). Typically, the entire involved fallopian tube is removed to prevent a recurrent ectopic pregnancy. Less commonly, after removal of the ectopic the fallopian tube is left in place. A ruptured ectopic pregnancy is a surgical emergency.

There is no specific treatment for the prevention of ectopic pregnancy. Women with a history of an ectopic should seek early care in their next pregnancy. If a fallopian tube has been removed or damaged by a previous ectopic, fertility treatments may help a woman become pregnant again.

For more information go to the American College of Obstetricians and Gynecologists at: www.acog.org/womens-health/ faqs/ectopic-pregnancy

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