In a normal pregnancy, the fertilized egg implants and develops in the uterus. In most ectopic pregnancies, the egg settles in the fallopian tubes. This is why ectopic pregnancies are commonly called "tubal pregnancies." The egg also can implant in the ovary, abdomen, or the cervix, so you also might hear these referred to as cervical or abdominal pregnancies.
None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth.
Signs and Symptoms
Ectopic pregnancy can be difficult to diagnose because symptoms often are like those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, fatigue, or frequent urination (peeing).
Often, the first warning signs of an ectopic pregnancy are pain or vaginal bleeding. There might be pain in the pelvis, abdomen, or even the shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). The pain can range from mild and dull to severe and sharp. It might be felt on just one side of the pelvis or all over.
Any of these symptoms also might happen with an ectopic pregnancy:
- vaginal spotting
- dizziness or fainting (caused by blood loss)
- low blood pressure (also caused by blood loss)
- lower back pain
What Causes an Ectopic Pregnancy?
An ectopic pregnancy usually happens because a fertilized egg wasn't able to quickly move down the fallopian tube into the uterus. An infection or inflammation of the tube might have partially or entirely blocked it. Pelvic inflammatory disease (PID), which can be caused by gonorrhea or chlamydia, is a common cause of fallopian tube blockage.
Endometriosis (when cells from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries also can cause blockages. More rarely, birth defects can change the shape of the tube and hurt the egg's progress.
If you go to the emergency department because of abdominal pain, you'll probably be given a urine pregnancy test. Although these tests aren't sophisticated, they are fast — and speed can be crucial in treating ectopic pregnancy.
If you already know you're pregnant, or if the urine test comes back positive, you may have a quantitative hCG test. This blood test measures levels of the hormone human chorionic gonadotropin (hCG), which is made by the placenta.
You also may have an ultrasound to look for a developing fetus in the uterus or elsewhere. Early in pregnancy, the ultrasound may be done using a wand-like device in your vagina. The doctor might give you a pelvic exam to locate the areas causing pain; to check for an enlarged, pregnant uterus; or to find any masses outside of the uterus.
Even with the best equipment, it's hard to see a pregnancy less than 5 weeks after the last menstrual period. If your doctor can't diagnose ectopic pregnancy but can't rule it out, he or she may ask you to return every few days for blood work and an ultrasound until it is clear whether or not there is an ectopic pregnancy.
Options for Treatment
Treatment of an ectopic pregnancy varies, depending on how medically stable the woman is and the size and location of the pregnancy.
An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which stops the growth of the embryo.
If the pregnancy is farther along, a woman will likely need surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring a large incision across the pelvic area, and this can still be necessary in cases of emergency or extensive internal injury.
But usually, ectopic tissue can be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes small incisions in the lower abdomen and then inserts a tiny video camera and instruments through these incisions. The image from the camera is shown on a screen in the operating room, allowing the surgeon to see what's going on inside of the body without making large incisions. The ectopic tissue is then surgically removed and any damaged organs are repaired or removed.
Whatever your treatment, the doctor will want to see you regularly afterward to make sure your hCG levels return to zero. This may take several weeks. An elevated hCG could mean that some ectopic tissue was missed. This tissue may have to be removed using methotrexate or more surgery.
What About Future Pregnancies?
Many women who have had an ectopic pregnancy will go on to have normal pregnancies in the future, but some will have difficulty becoming pregnant again. This difficulty is more common in women who also had fertility problems before the ectopic pregnancy. It depends on a woman's fertility before the ectopic pregnancy, as well as the extent of any damage that happened.
A woman who has had one ectopic pregnancy has about a 15% chance of having another.
Who's at Risk for an Ectopic Pregnancy?
While any woman can have an ectopic pregnancy, the risk is higher for women who are older than 35 and those who have had:
- a previous ectopic pregnancy
- surgery on a fallopian tube
- infertility problems or medication to stimulate ovulation
Some birth control methods also can affect a woman's risk of ectopic pregnancy. Those who become pregnant while using an intrauterine device (IUD) might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also increase the risk of an ectopic pregnancy.
When to Call Your Doctor
If you believe you're at risk for an ectopic pregnancy, meet with your doctor to discuss your options before you become pregnant. You can help protect yourself against a future ectopic pregnancy by not smoking and by always using condoms when you're having sex but not trying to get pregnant. Condoms can protect against sexually transmitted infections (STDs) that can cause PID.
If you are pregnant and have any concerns about the pregnancy being ectopic, talk to your doctor — it's important to make sure it's detected early. You and your doctor might want to plan on checking your hormone levels or scheduling an early ultrasound to ensure that your pregnancy is developing normally.
Call your doctor immediately if you're pregnant and experiencing any pain, bleeding, or other symptoms of ectopic pregnancy. When it comes to detecting an ectopic pregnancy, the sooner it is found, the better.
Reviewed by: Larissa Hirsch, MD
Date reviewed: May 2015
|Maternal and Child Health Bureau This U.S. government agency is charged with promoting and improving the health of mothers and children.|
|Planned Parenthood Federation of America Planned Parenthood offers information on sexually transmitted diseases, birth control methods, and other issues of sexual health.|
|American Pregnancy Association This national organization promotes reproductive and pregnancy wellness.|
|American College of Obstetricians and Gynecologists (ACOG) This site offers information on numerous health issues. The women's health section includes readings on pregnancy, labor, delivery, postpartum care, breast health, menopause, contraception, and more.|
|WomensHealth.gov The Office on Women's Health (OWH), part of the U.S. Department of Health and Human Services (HHS), offers reliable health and wellness information for women and girls.|
|Pregnancy Precautions: FAQs Questions regarding what you can and can't do during pregnancy abound. Knowing what could truly be harmful to your baby versus what's no real cause for concern is key to keeping your sanity throughout the 40 weeks.|
|What Is the Risk for a Second Ectopic Pregnancy? Find out what the experts have to say.|
|Pelvic Inflammatory Disease Pelvic inflammatory disease (PID) is a serious infection of the female reproductive organs that may cause severe symptoms, minor symptoms, or no symptoms at all.|
|Menstrual Problems For a girl, getting her first period is a sign of becoming a woman. But it can also be confusing, particularly if she encounters certain menstrual problems.|
|What Precautions Should I Take While Trying to Conceive? Find out what the experts have to say.|
|Miscarriages Miscarriages are common, and in most cases aren't preventable. But you can take steps to increase your chances of having a healthy pregnancy.|
|Female Reproductive System Without the female reproductive system, there would be no perpetuation of life. Understanding it, what it does, and the problems that can affect it may help you better understand your own daughter's reproductive health.|
Note: All information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.
© 1995-2016 KidsHealth® All rights reserved.
Images provided by iStock, Getty Images, Corbis, Veer, Science Photo Library, Science Source Images, Shutterstock, and Clipart.com