An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies occur in a fallopian tube. As the pregnancy grows, it can cause the tube to burst, leading to major internal bleeding. This can be life-threatening and typically requires surgical intervention.
In some instances, if the tube has not ruptured, an ectopic pregnancy can be managed medically or surgically.
Who is at Risk?
Women who are sexually active and of childbearing age are at risk. Women with abnormal fallopian tubes are at a higher risk. Abnormal tubes may be present in women who have:
- Pelvic inflammatory disease
- A previous ectopic pregnancy
- Infertility
- Pelvic or abdominal surgery
- Endometriosis
- A sexually transmitted disease
- Prior tubal surgery
- Cigarette smoking
- Exposure to the drug diethylstilbestrol (DES) during her mother’s pregnancy
- Increased age
Symptoms
If an ectopic pregnancy can be identified early, it can be treated before the tube bursts. Many of the symptoms include those typical of pregnancy, such as tender breasts and an upset stomach. If you have any of these symptoms, contact your healthcare provider.
- Abnormal bleeding: Bleeding that does not coincide with your menstrual period. This may be heavy or light.
- Abdominal or pelvic pain: This can be sudden and sharp or come and go. It may only occur on one side.
- Shoulder pain: If blood from a ruptured tube builds up under the diaphragm, it can cause pain that is felt in the shoulder.
- Weakness, dizziness, or fainting: These symptoms can result from blood loss.
Diagnosis
If your healthcare provider believes you may have an ectopic pregnancy, they will:
- Perform a pelvic exam
- Check your blood pressure and pulse
- Perform an ultrasound of the pelvis
- Conduct a blood test to check the level of the hormone human chorionic gonadotropin (hCG), which is produced during pregnancy.
Tests to confirm an ectopic pregnancy take time, and results might not be available right away. If a ruptured ectopic pregnancy is suspected, emergency surgery will be needed.
Treatment
Ectopic pregnancy can be treated with medication or surgery. If your healthcare provider believes you have an ectopic pregnancy, they will discuss the best treatment options with you based on your condition and future plans for pregnancy.
Medication
If the pregnancy is small and has not ruptured, medication can be used to treat it. The medication helps stop the growth of the pregnancy and allows the body to absorb it over time, preserving the fallopian tube.
Methotrexate is the most common medication used to treat an ectopic pregnancy. It is administered by injection in one dose. In some cases, several doses may be given over a period of days.
During this treatment, you should avoid:
- Alcohol
- Vitamins containing folic acid
- Nonsteroidal anti-inflammatory drugs such as ibuprofen
- Sex
Side effects include:
- Abdominal pain
- Vaginal bleeding or spotting
- Nausea
- Vomiting
- Diarrhea
- Dizziness
While taking the medication, the risk of a tubal rupture does not go away. Contact your healthcare provider immediately if you experience:
- Sudden, severe abdominal pain
- A major increase in abdominal pain
- Heavy vaginal bleeding
- Dizziness, fainting, or rapid heartbeat
Surgery
If the pregnancy is small and has not ruptured, the pregnancy may be removed through a small cut in the tube during a laparoscopy. The procedure will be done in the hospital under general anesthesia. A larger incision in the abdomen may be needed if the pregnancy is large or if blood loss is a concern. Some or all of the fallopian tube may need to be removed.
If the tube has burst, emergency surgery will be needed to stop the bleeding promptly. If little damage has been done to the fallopian tube, it may be repaired. However, a ruptured tube often must be removed.
