Ectopic Pregnancy

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that takes place outside the uterus. The most common site of an ectopic pregnancy is one of the fallopian tubes. This is also referred to as a tubal pregnancy. Other sites include the ovary and, rarely, in the abdominal cavity or cervix.  Once a pregnancy is planted in the tube, ovary or abdominal wall, it can not be changed and must be ended as soon as possible.

How does it occur?

An egg from the ovary is fertilized by a sperm and becomes implanted outside of the uterus, usually in the fallopian tube. As the fertilized egg enlarges, the fallopian tube stretches and ruptures, which causes life-threatening internal bleeding.

What causes this to happen?

Conditions that may cause this are:
            *a previous infection that caused scar tissue to form in the fallopian tubes,
               such as Chlamydia, gonorrhea or PID (pelvic inflammatory disease).
            *surgery on the tubes, ovaries, or a ruptured appendix. For example,
               reversing a tubal ligation.
            *adhesions (bands of scar tissue) from a previous abdominal surgery.
            *birth defects in the fallopian tubes.
            *endometriosis, which is a growth of tissue from the lining of the uterus
              outside the uterus.
            *a previous ectopic pregnancy.
            *a tumor.
            *assisted reproduction techniques such as in vitro fertilization.
            *use of an intrauterine device (IUD) that results in a pelvic infection.

Also, you have a greater chance of having an ectopic pregnancy if:
            *Your mother was exposed to DES.
            *You smoke.
            *You have had a ruptured appendix.
            *You have had problems getting pregnant.
            *The risk of ectopic pregnancy increases as you get older.

What are the symptoms?

Ectopic pregnancies are usually diagnosed within the first 8 weeks of pregnancy, possibly before you know you are pregnant. The symptoms are different depending on what stage of the pregnancy you are in.

The early stages symptoms include:
            * missed period or abnormal bleeding.
            *unexplained vaginal spotting or bleeding.
            * pain in the lower abdomen or pelvis and cramps.
            * symptoms of pregnancy such as breast tenderness or morning sickness.
            *pain in the shoulder (rare).
           
The late stages symptoms include:
            *sudden, sharp, severe abdominal pain (caused by the rupture of the fallopian
              tube).
            *dizziness, fainting and shock (paleness, rapid heartbeat, drop in blood
              pressure and cold sweats).

Many times a tubal pregnancy will rupture and cause severe pain while you are having a bowel movement, especially if you are having trouble passing the bowel movement or are constipated.

How is it diagnosed?

There are blood tests that can be used to help diagnose an ectopic pregnancy. The Beta HCG hormone should double or triple every couple of days. If this does not occur, you will be having frequent blood draws and ultrasounds in order to determine if the pregnancy is normal, ectopic or a miscarriage. The progesterone level is also drawn and it may be low with an ectopic pregnancy.  In addition to blood tests and a pregnancy test, the following procedures may be done:

Ultrasound scan to see if the fertilized egg is in the uterus or a fallopian tube. This may have to be repeated weekly until you are far enough along in the pregnancy to detect the pregnancy in the uterus or tube.

Culdocentesis, which is the insertion of a needle through the vagina behind the uterus. This is a way to look for blood in the pelvis that could be evidence of a ruptured fallopian tube.

Laparoscopy, which is the insertion of a lighted instrument into the abdomen through a cut in the bellybutton to look at the pelvis and tubes. An ectopic pregnancy can be seen even before it ruptures and may be removed with this procedure.

How is it treated?

If an ectopic pregnancy is diagnosed very early in pregnancy (within the first 6 weeks), it can be treated and the pregnancy ended with medicine (methotrexate). This medication is given as a shot into the buttocks. Blood tests will have to be done at least weekly to monitor your Beta HCG hormone levels as well as your liver enzyme levels. We will need to monitor the Beta HCG hormone until the number decreases to a negative result. Otherwise, you will need surgery to remove the pregnancy. In some cases this surgery can be done through a laparoscope. Abdominal surgery (laparotomy) may be needed if there is heavy bleeding into the abdomen and if the fallopian tube has ruptured and needs repair. Any damaged tissue, such as all or part of a fallopian tube, will be repaired or removed.

How long will the effects last?

The effects last as long as you have the ectopic pregnancy. Without treatment this condition can cause serious problems, including death.

How can I take care of myself?

The best way to take care of yourself is to pay close attention to your health. Pay attention to changes related to your menstrual cycle. Call the office about any abnormal bleeding or unusual pain between menstrual periods. Call the office as soon as you think you are pregnant, especially if you have an increased risk for ectopic pregnancy.

How can I prevent an ectopic pregnancy?

There is not a way to prevent all ectopic pregnancies. You can, however, reduce your chance by reducing your risk factors. For example, pelvic inflammatory disease (PID) is the most common and preventable cause of ectopic pregnancy. Sexually transmitted diseases, such as gonorrhea and chlamydia, can cause PID. Always practice safe sex by using a latex or polyurethane condom to reduce your chances of infection.

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