Ectopic Pregnancy

Symptoms

• A missed menstrual period.
• Abdominal or pelvic pain, which may be on one side and can feel sharp, dull, or like cramping.
• Vaginal bleeding or light spotting, which is often dark and watery, sometimes described as looking like 'prune juice'.
• Symptoms of early pregnancy, such as nausea and breast tenderness.
• Dizziness, lightheadedness, or weakness.
• Rectal pressure or pain during bowel movements.
• EMERGENCY SYMPTOMS OF RUPTURE: Seek immediate medical help if you experience sudden, severe, sharp pain in the lower abdomen.
• EMERGENCY SYMPTOMS OF RUPTURE: Shoulder tip pain, which is caused by internal bleeding irritating the diaphragm.
• EMERGENCY SYMPTOMS OF RUPTURE: Severe dizziness, fainting, or collapse.
• EMERGENCY SYMPTOMS OF RUPTURE: Signs of shock, such as a rapid heart rate, pale skin, and clamminess.

Causes & Risk Factors

• The primary cause is a condition that slows or blocks the fertilized egg's journey through the fallopian tube to the uterus.
• Damage to the fallopian tube from inflammation or scarring is a common cause. This can result from a previous infection, such as pelvic inflammatory disease (PID), often caused by chlamydia or gonorrhea.
• Scar tissue (adhesions) from previous surgeries in the abdomen or on the fallopian tubes can obstruct the egg's path.
• The shape or function of the fallopian tube may be affected by congenital abnormalities or hormonal factors.
• In about one-third to one-half of cases, there are no identifiable risk factors, and the specific cause remains unknown.
• Previous ectopic pregnancy (the strongest risk factor).
• History of pelvic inflammatory disease (PID) or other sexually transmitted infections (STIs) like chlamydia and gonorrhea.
• Previous surgery on the fallopian tubes (including tubal ligation) or in the pelvic/abdominal area.
• Fertility treatments, such as in vitro fertilization (IVF).
• History of infertility.
• Currently using an intrauterine device (IUD) for contraception.
• Cigarette smoking.
• Increasing age, particularly over 35.
• In utero exposure to the medication diethylstilbestrol (DES).

Diagnosis

• Medical History: Your doctor will discuss your symptoms, menstrual cycle, and any risk factors you may have.
• Physical Exam: A pelvic and abdominal exam is performed to check for pain, tenderness, or any unusual masses.
• Blood Tests (Quantitative β-hCG): This test measures the level of the pregnancy hormone hCG. In a normal pregnancy, this level rises predictably. A slow rise, plateau, or decline in hCG levels can indicate an ectopic pregnancy or a miscarriage. The test is usually repeated every 48 hours.
• Transvaginal Ultrasound: This is the primary imaging tool used for diagnosis. A small ultrasound probe is placed in the vagina to get a clear view of the uterus and fallopian tubes. It can confirm if a pregnancy is located inside or outside the uterus.
• Correlation of hCG and Ultrasound: Diagnosis is typically confirmed by combining the results of hCG blood tests and ultrasound findings. If hCG levels are above a certain point (the 'discriminatory zone') but no pregnancy is seen inside the uterus, an ectopic pregnancy is highly suspected.
• Laparoscopy: In some cases where the diagnosis is uncertain, a minimally invasive surgical procedure called laparoscopy may be needed to directly visualize the pelvic organs and confirm the location of the pregnancy.

Treatment Options

• Expectant Management (Watchful Waiting): In select cases where the pregnancy is very early, symptoms are absent, and hCG hormone levels are low and decreasing, it may be possible to monitor the situation closely to see if the pregnancy resolves on its own.
• Medical Treatment (Methotrexate): For stable patients who meet specific criteria, an injection of a medication called methotrexate can be used. This drug stops the growth of the pregnancy cells, which are then reabsorbed by the body. This approach avoids surgery but requires careful follow-up with blood tests.
• Surgical Treatment: Surgery is often necessary, especially if there is a risk of rupture or heavy bleeding. The preferred method is laparoscopy, a minimally invasive surgery using small incisions.
• Salpingostomy: During surgery, an incision is made in the fallopian tube to remove the ectopic pregnancy, and the tube is left to heal. This may be an option for those who wish to preserve the tube for future fertility.
• Salpingectomy: This procedure involves the complete removal of the fallopian tube containing the pregnancy. It is often recommended if the tube is severely damaged or if the other tube is healthy.
• Laparotomy: In an emergency, such as a ruptured ectopic pregnancy with severe internal bleeding, a larger abdominal incision (laparotomy) is required for immediate surgical intervention.
• Rh(D) Immunoglobulin: If your blood type is Rh-negative, you will be given an injection of Rh immunoglobulin (like Rhogam) to prevent complications in future pregnancies.

Frequently Asked Questions