Ectopic Pregnancy

An ectopic pregnancy is a condition in which a fertilized egg develops outside the uterus. It may be implanted in the cervix of the uterus, the fallopian tubes (which normally carry the egg from the ovary to the uterus), within an ovary or inside the abdominal or pelvic cavity.

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Symptoms

The signs of an ectopic pregnancy are like those of a threatened abortion. Bleeding from the uterus is often followed by cramping and bleeding from the tube. In a tubal pregnancy, spotting and cramping pain usually begin shortly after the first missed menstrual period. Gradual bleeding from the tube causes pain and pressure inside the pelvis. If rapid bleeding occurs because the tube has ruptured, the patient may experience a loss of blood pressure and shock.

Causes and Risk Factors

A woman who has an intrauterine device in place who becomes pregnant (a rare event) has a much higher than normal risk of an ectopic pregnancy. A woman's risk of an ectopic pregnancy also increases if she has had:

  • A tubal disorder
  • A prior ectopic pregnancy
  • Exposure to DES
  • An induced abortion

The most common site of an ectopic pregnancy is a uterine tube. In about half the cases, this type of ectopic pregnancy is caused by a previous tubal infection. Pregnancies that occur in the cervix, ovaries or abdominal cavity are rare.

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Diagnosis

To diagnose an ectopic pregnancy, a doctor first performs a physical exam to look for signs of bleeding, shock and irritation of the lining of the abdomen. Tenderness may be apparent on a single side of the abdomen. A pelvic examination may show that the uterus is enlarged, but it will be smaller than expected from the estimated due date. Other symptoms include:

  • Tenderness of the cervix to motion
  • Being able to feel a tender mass in one ovary or fallopian tube
  • A bulging cul-de-sac

If a woman is pregnant based on tests and an ectopic pregnancy is suspected, an ultrasound is usually done. Laparoscopy confirms the diagnosis. If the ectopic pregnancy has not been found in six to eight weeks, the woman may feel marked, sudden, lower abdominal pain, which may be followed by fainting. These symptoms usually indicate that the tube has ruptured and is bleeding inside the abdomen.

A pregnancy in which the fertilized egg is located around where the fallopian tubes reach the uterus (a cornual pregnancy) can remain viable longer because the wall of the uterus provides support and delays a rupture. In this situation, a doctor can feel that the uterus is not regular in shape. It may be tender to the touch, and the patient may have cramping and spotting. Between 12 and 16 weeks, this type of pregnancy will usually rupture, possibly becoming life threatening and requiring a hysterectomy (an operation in which the uterus is removed).

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Treatments

Without treatment, an ectopic pregnancy is usually fatal.

Even if a tubal pregnancy is found before it ruptures, surgery is usually needed. During this type of surgery every effort is made to conserve the fallopian tube. If the tube is too damaged, reconstructive surgery may be needed later, which may allow for future pregnancies.

After a cornual pregnancy, the tube and ovary involved can usually be saved, and the uterus can be repaired. However, the fallopian tube may need to be reattached. In rare cases, a repair cannot be made, and a hysterectomy is needed.