In a normal pregnancy, your ovary releases an egg into your fallopian tube. If the egg meets with a sperm, the fertilized egg moves into your uterus to attach to its lining and continues to grow for the next 9 months.
But in up to 1 of every 50 pregnancies, the fertilized egg stays in your fallopian tube. In that case, it’s called an ectopic pregnancy or a tubal pregnancy. In rare cases, the fertilized egg attaches to one of your ovaries, another organ in your abdomen, the cornua (or horn) of the uterus or even the cervix. In any case, instead of celebrating your pregnancy, you find your life is in danger. Ectopic pregnancies require emergency treatment.
Most often, ectopic pregnancy happens within the first few weeks of pregnancy. You might not even know you’re pregnant yet, so it can be a big shock. Doctors usually discover it by the 8th week of pregnancy.
Ectopic pregnancies can be scary and sad.
Causes of 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. Certain risk factors exist for ectopic pregnancy. A risk factor is a trait or behavior that increases a person’s chance of developing a disease or predisposes a person to a certain condition. Risk factors for ectopic pregnancy include:
being over age 35
use of an intrauterine device (IUD), a form of birth control, at the time of conception history of pelvic inflammatory disease (PID) sexually-transmitted diseases such as chlamydia and gonorrhea congenital (present at birth) abnormality of the fallopian tube history of pelvic surgery — Scarring might block the fertilized egg from leaving the fallopian tube.
history of ectopic pregnancy
tubal ligation (surgical sterilization), unsuccessful tubal ligation, or reversal of tubal ligation
use of fertility drugs
infertility treatments such as in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT)
Symptoms of an ectopic pregnancy
Common symptoms of an ectopic pregnancy include:
signs of early pregnancy
lower abdominal or pelvic pain
dizziness or weakness
low back pain.
If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause fainting, low blood pressure, shoulder pain, and rectal pressure. Sudden lower abdominal pain can be sharp. Contact your health care provider if you have any of the above symptoms.
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 health care provider right away, as ectopic pregnancies are more common in these situations.
How an ectopic pregnancy is diagnosed
A health care provider will perform a pregnancy test, a pelvic exam, and a vaginal ultrasound test to view the condition of the uterus and fallopian tubes.
Most ectopic pregnancies can be detected using a pelvic exam, ultrasound, and blood tests. If you have symptoms of a possible ectopic pregnancy, you will have:
A pelvic exam, which can detect tenderness in the uterus or fallopian tubes, less enlargement of the uterus than expected for a pregnancy, or a mass in the pelvic area.
A pelvic ultrasound (transvaginal or abdominal), which uses sound waves to produce a picture of the organs and structures in the lower abdomen. A transvaginal ultrasound is the most dependable way to show where a pregnancy is. A pregnancy in the uterus is visible 6 weeks after the last menstrual period. An ectopic pregnancy is likely if there are no signs of an embryo or fetus in the uterus but hCG levels are elevated or rising.
Sometimes a surgical procedure using laparoscopy is used to look for an ectopic pregnancy.
In some cases, medicine might be used to stop the growth of pregnancy tissue. If there is a ruptured fallopian tube, emergency surgery might be necessary to stop the bleeding. A laparotomy (a procedure during which an incision is made in the abdomen and the embryonic tissue is removed) might be needed if the embryo is large or blood loss is considered life-threatening. Laparoscopic surgery (minimally invasive surgery) might be appropriate if the fallopian tube is not ruptured and the pregnancy has not progressed very far. In some cases, the fallopian tube and ovary might be damaged and have to be removed, depending on the progression of the pregnancy.
Most women who have had an ectopic pregnancy can go on to have subsequent normal pregnancies and births. A future successful pregnancy will depend on the why the first ectopic pregnancy occurred, the age of the woman and if the woman already had children. Discuss the timing of your next pregnancy with your health care provider.
You cannot prevent ectopic pregnancy, but you can prevent serious complications with early diagnosis and treatment. If you have one or more risk factors for ectopic pregnancy, you and your doctor can closely monitor your first weeks of a pregnancy.
If you smoke, quit to lower your risk of ectopic pregnancy. Women who smoke or who used to smoke have higher rates of ectopic pregnancy.
Using safer sex practices, such as using a male condom or a female condom every time you have sex helps protect you from sexually transmitted infections (STIs) that can lead to pelvic inflammatory disease (PID). PID is a common cause of scar tissue in the fallopian tubes, which can cause ectopic pregnancy.