Ectopic Pregnancy

Overview

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that happens outside of the uterus. This happens when a fertilized egg implants in a structure that can’t support its growth. An ectopic pregnancy often happens in the fallopian tube (a pair of structures that connect the ovaries and uterus). In rare cases, an ectopic pregnancy can occur on an ovary or in the abdominal cavity.

This is a life-threatening condition. An ectopic pregnancy is not a pregnancy that can be carried to term (till birth) and can be dangerous for the mother if not treated right away.

Where does an ectopic pregnancy happen?

It’s considered an ectopic pregnancy whenever the fertilized egg implants outside of your uterus. The egg is meant to travel down the fallopian tubes and imbed itself into the wall of your uterus, where it can begin to develop. In an ectopic pregnancy, the egg implants in one of the structures along the way. The most common place this can happen is within the fallopian tubes. The majority of ectopic pregnancies happen here—called a tubal ectopic pregnancy. A fertilized egg can also implant on other organs in your abdominal cavity. This is a rarer form of ectopic pregnancy than one that happens in a fallopian tube.

How serious is an ectopic pregnancy?

An ectopic pregnancy is a medical emergency. The uterus is uniquely suited to hold a growing fetus. It’s an organ that can stretch and expand as the fetus grows. Your fallopian tubes aren’t as flexible. They can burst as the fertilized egg develops. When this happens, you can experience large amounts of internal bleeding. This is life threatening. An ectopic pregnancy needs to be treated right away to avoid injury to the fallopian tube, other organs in the abdominal cavity, internal bleeding and death.

Can my pregnancy continue after an ectopic pregnancy?

Unfortunately, an ectopic pregnancy is fatal for the fetus. It cannot survive outside of the uterus. Quick treatment for an ectopic pregnancy is important to protect the mother’s life. If the egg has implanted in the fallopian tube and the tube bursts, there can be severe internal bleeding. This can lead to maternal death.

Symptoms and Causes

What causes an ectopic pregnancy?

In most cases, an ectopic pregnancy is caused by conditions that slow down or block the movement of the egg down the fallopian tube and into the uterus.

How do I know if I’m at risk of an ectopic pregnancy?

There are several risk factors that could increase your chance of developing an ectopic pregnancy. A risk factor is a trait or behavior that increases your chance for developing a disease or condition. You may be at a higher risk of developing an ectopic pregnancy if you’ve had:

  • A previous ectopic pregnancy.
  • A history of pelvic inflammatory disease (PID), an infection that can cause scar tissue to form in your fallopian tubes, uterus, ovaries and cervix.
  • Surgery on your fallopian tubes (including tubal ligation, also referred to as having your tubes tied) or on the other organs of your pelvic area.
  • A history of infertility.
  • Treatment for infertility with in vitro fertilization (IVF).
  • Endometriosis.
  • Sexually transmitted infections (STIs).
  • An intrauterine device (IUD), a form of birth control, in place at the time of conception.
  • A history of smoking.

Your risk can also increase as you get older. Women over age 35 are more at risk than younger women.

Many women who experience an ectopic pregnancy don’t have any of the above risk factors.

What are the symptoms of an ectopic pregnancy?

The early symptoms of an ectopic pregnancy can be very similar to typical pregnancy symptoms. However, you may experience additional symptoms during an ectopic pregnancy, including:

  • Vaginal bleeding.
  • Pain in your lower abdomen, pelvis and lower back.
  • Dizziness or weakness.

If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause additional symptoms. These can include:

When a tube bursts, you may feel sharp lower abdominal pain. This is a medical emergency and you will need to contact your healthcare provider or go to the emergency room immediately.

If you realize that you are pregnant and have an IUD (intrauterine device for contraception) in place, or have a history of a tubal ligation (having your tubes tied by surgery or at the time of a C-section), contact your healthcare provider right away. Ectopic pregnancy is more common in these situations.

Diagnosis and Tests

How is an ectopic pregnancy diagnosed?

An ectopic pregnancy is typically diagnosed during an appointment in your healthcare provider’s office. Your provider will perform several tests to first confirm a pregnancy, and then look for the ectopic pregnancy. These tests include:

  • A urine test: This test involves either urinating on a test strip (typically shaped like a stick) or urinating into a cup in your provider’s office and then having a test strip dipped into the urine sample.
  • A blood test: You provider may test your blood to see how much of the hormone human chorionic gonadotropin (hCG) you have in your body. This hormone is produced during pregnancy. You may also hear this called your serum beta-hCG level.
  • An ultrasound exam: An imaging test, an ultrasound uses sound waves to create a picture of your body’s internal structures. Ultrasound is often used during pregnancy. Your provider will use this test to see where the fertilized egg has implanted.

Once your provider has confirmed the pregnancy and determined where the fertilized egg has implanted, a treatment plan will be created. Ectopic pregnancy is an emergency and treatment for this condition is very important.

If your fallopian tube ruptures, you will need to go to the emergency room and be treated immediately. In those cases, there’s no time to wait for an appointment.

How early in a pregnancy is an ectopic pregnancy detected?

Ectopic pregnancy is typically discovered very early in pregnancy. Most cases are found within the first trimester (the first three months). It usually is discovered by the eighth week of pregnancy.

Management and Treatment

How is an ectopic pregnancy treated?

There are several ways that an ectopic pregnancy can be treated. In some cases, your provider may suggest using a medication called methotrexate to stop the growth of the pregnancy. This will end your pregnancy. Methotrexate is given in an injection by your healthcare provider. This option is less invasive than surgery, but it does require follow-up appointments with your provider where you hCG levels will be monitored.

In severe cases, surgery is often used. Your provider will want to operate when your fallopian tube has ruptured or if you are at a risk of rupture. This is an emergency surgery and a life-saving treatment. The procedure is typically done laparoscopically (through several small incisions instead of one bigger cut). The surgeon may remove the entire fallopian tube with the egg still inside it or remove the egg from the tube if possible.

Prevention

Can I prevent an ectopic pregnancy?

An ectopic pregnancy cannot be prevented. But you can try to reduce your risk factors by following good lifestyle habits. These can include not smoking, maintaining a healthy weight and diet, and preventing any sexually transmitted infections (STIs). Talk to your healthcare provider about any risk factors you may have before trying to become pregnant.

Outlook / Prognosis

Can I get pregnant again after an ectopic pregnancy?

Most women who have had an ectopic pregnancy can go on to have future successful pregnancies. There is a higher risk of having future ectopic pregnancies after you have had one. It’s important to talk to your healthcare provider about the causes of your ectopic pregnancy and what risk factors you may have that could cause a future ectopic pregnancy.

How long should I wait before becoming pregnant again after an ectopic pregnancy?

You should talk to your healthcare provider about future pregnancies after being treated for an ectopic pregnancy. Although pregnancy may happen quickly after treatment, it’s often best to wait about three months. This allows your fallopian tube time to heal and decreases the risk of another ectopic pregnancy.

If my fallopian tube is removed, can I still have a baby?

In most cases, you can still have a baby if you have had one of your fallopian tubes removed. You have a pair of fallopian tubes and eggs can still travel down your remaining tube. There are also assisted fertility procedures where the egg is extracted from the ovary, fertilized outside of the body and placed in the uterus for implantation. This is called in vitro fertilization (IVF).

Have an open conversation about your thoughts on future pregnancies with your healthcare provider. Together, you can form a plan and discuss ways to decrease any risk factors you may have.

Last reviewed by a Cleveland Clinic medical professional on 02/06/2020.

References

  • The American College of Obstetricians and Gynecologists. Ectopic Pregnancy. (https://www.acog.org/Patients/FAQs/Ectopic-Pregnancy?IsMobileSet=false) Accessed 2/7/2020.
  • American Pregnancy Association. Ectopic Pregnancy. (https://americanpregnancy.org/pregnancy-complications/ectopic-pregnancy/) Accessed 2/7/2020.
  • Merck Manual Professional Version. Ectopic Pregnancy. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/ectopic-pregnancy) Accessed 2/7/2020.
  • Tenore J. Ectopic Pregnancy. (https://www.aafp.org/afp/2000/0215/p1080.html) American Family Physician. Feb 2000. 15;61(4): 1080-1088. Accessed 2/7/2020.
  • Tay J, Moore J, Walker J. Ectopic pregnancy. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071024/) Western Journal of Medicine. Aug 2000; 173(2): 131-134. Accessed 2/7/2020.
  • Lee R, Dupuis C, Chen B. Diagnosing ectopic pregnancy in the emergency setting. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769947/) Ultrasonography. Jan 2018; 37(1): 78-87. Accessed 2/7/2020.

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