Ectopic Pregnancy

An ectopic pregnancy occurs when a fertilized egg (embryo) implants outside of the uterus rather than inside it. This occurs in the fallopian tubes more than 90% of the time. An ectopic pregnancy cannot result in a healthy pregnancy. Rather, it poses a risk for tubal rupture, which can endanger the mother and can result in a life-threatening loss of blood. An ectopic pregnancy requires immediate treatment with either medication or surgery to help ensure the well-being of the mother.

A woman’s chance of future pregnancy success after this type of pregnancy is usually above 65%, and this relates directly to the function and patency (being unobstructed) of her fallopian tubes.

What is an ectopic pregnancy, and why is it commonly referred to as a tubal pregnancy?

This unhealthy pregnancy occurs when an embryo fails to travel from the fallopian tube to implant in the uterus. According to the American College of Obstetricians and Gynecologists (ACOG), more than 90% of ectopic pregnancies occur in the fallopian tube, which is known as a tubal pregnancy. The embryo may also attach in other portions of the body, particularly the abdominal cavity, ovary or cervix.

In a normal pregnancy, the embryo travels through the fallopian tube and into the uterus (womb), where it implants and is nourished throughout the pregnancy. But if the fallopian tube is blocked or is damaged and cannot function properly, the embryo is unable to traverse through the fallopian tube into the uterus, and it thus most often attaches inside the tube.

Whether it implants in the tube or somewhere else outside the uterus, this type of pregnancy does not result in a live birth because the embryo cannot be properly nourished and survive. Therefore, the pregnancy should be ended as soon as it is detected through treatment with medication or surgery.

As this type of pregnancy progresses, it can rupture the fallopian tube or damage the area where it has implanted. This can cause considerable internal bleeding and can become life threatening for the mother, requiring immediate surgery.

An ectopic (meaning out of place or position) pregnancy occurs in 1%-2% of all pregnancies, according to the National Institutes of Health. The rate of occurrence is thought to be 2%-5% for women who use assisted reproductive technology to achieve pregnancy.

Its effect on a woman’s fertility

Ectopic pregnancies are usually detected early on with monitoring by the woman’s OB-GYN. This increases the chance of the woman having a successful pregnancy later. While an ectopic pregnancy can cause subsequent infertility, about 65% of women who have had this condition have a healthy pregnancy within 18 months. And the chances appear to increase after additional time.

A woman’s chance of future pregnancy success after an ectopic pregnancy is usually related to the health of her fallopian tubes. Our fertility specialists can evaluate a woman’s tubal health and possible infertility after this type of pregnancy, and advise her on options for future pregnancy.

Women who have had an ectopic pregnancy are at higher risk of having another one. It’s important to be aware of the signs and symptoms of ectopic pregnancies during future pregnancies. Women who become pregnant again after having an ectopic one should consult their OB-GYN to confirm the pregnancy is in the uterus.

Causes of an ectopic pregnancy and risk factors

In many instances the cause of this unhealthy pregnancy isn’t ever determined. The reason why an embryo may not make its way inside the uterus is most often caused by a scarred or damaged fallopian tube that blocks the embryo’s passage.

Damage to the fallopian tubes can be caused by the following:

• Scar tissue caused by endometriosis.
• Pelvic inflammatory disease (PID).
• Infections caused by sexually transmitted diseases such as chlamydia or gonorrhea.
• Partial or complete blockages in the tubes, either at the ends or in the middle.
• Prior pelvic or fallopian tube surgery.

Risk factors

Oftentimes women who experience ectopic pregnancies have no known risk factors. But increased risk factors for one, in addition to the causes of fallopian tube damage listed above, include women:

• With a history of ectopic pregnancy.
• Who smoke cigarettes.
• Who have conceived with an IUD in place.
• Who have tried to have their tubes tied (tubal ligation) and failed, or who have had tubal ligation reversal.
• Who use fertility drugs.
• Who have had prior fertility treatment
• With hormone imbalances or abnormal embryo development.

Symptoms of this type of pregnancy

Common symptoms of an ectopic pregnancy also occur in normal uterine pregnancies and can include a missed period, nausea and breast soreness. A pregnancy test will present a positive result with an ectopic pregnancy.

This type of pregnancy can cause a woman to experience sharp waves of pain, light vaginal bleeding, dizziness or fainting. Some women may also experience urges to have a bowel movement.

More severe symptoms can cause heavy bleeding (likely due to a fallopian tube rupture), severe pain in the abdomen or pelvis, weakness, more severe dizziness or fainting. Contact a doctor immediately if any of these symptoms appear.

Ectopic pregnancy treatment

This pregnancy always requires treatment since the embryo can’t be moved to the uterus to complete the pregnancy. The woman’s symptoms and how far along in the pregnancy she is will determine treatment to end the pregnancy.

If ectopic pregnancy is diagnosed early, a medication called methotrexate, which is a drug that stops the embryo cells from growing, will be prescribed. If detected early enough, almost 90% of ectopic pregnancies can be successfully treated with this medication.

To prevent life-threatening concerns or in the case of a tubal pregnancy, laparoscopic surgery is required. This procedure is minimally invasive and involves small incisions in the abdomen. A small camera is inserted through the incision and the pregnancy is located. Once the surgeon identifies the pregnancy, additional instruments are utilized to remove the ectopic pregnancy.

In some cases, a laparotomy may be required if the ectopic pregnancy can’t be removed due to a larger amount of internal bleeding or scar tissue. This procedure consists of a larger incision in the abdomen followed by removal of the ectopic pregnancy.

There are instances where removal of the fallopian tubes is required. If so, fertility treatments such as in vitro fertilization (IVF) offer options to become pregnant.

In some cases, surgery may cause damage or scarring to the fallopian tubes, which will increase the likelihood of ectopic pregnancy.

If at least one fallopian tube is still intact, most women can go on to have a healthy pregnancy after experiencing an ectopic pregnancy. For women who have difficulty getting pregnant after having an ectopic pregnancy, fertility testing and treatment can improve their chances.