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Ectopic pregnancy

An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother.

Alternative Names

Tubal pregnancy; Cervical pregnancy; Tubal ligation-ectopic pregnancy

Causes

In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include:

  • Birth defect in the fallopian tubes
  • Scarring after a ruptured appendix
  • Endometriosis
  • Having had a previous ectopic pregnancy
  • Scarring from past infections or surgery of the female organs

The following also increase risk of an ectopic pregnancy:

  • Age over 35
  • Getting pregnant while having an intrauterine device (IUD)
  • Having your tubes tied (tubal ligation): This is more likely 2 or more years after the procedure
  • Having had surgery to untie tubes (tubal sterilization) to become pregnant
  • Having had many sexual partners
  • Some infertility treatments

Sometimes the cause is unknown. Hormones may play a role.

The most common site for an ectopic pregnancy is within one of the two fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix .

An ectopic pregnancy can occur even if you use birth control.

Symptoms

You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include:

  • Abnormal vaginal bleeding
  • Low back pain
  • Mild cramping on one side of the pelvis
  • No periods
  • Pain in the lower belly or pelvic area

If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:

  • Fainting or feeling faint
  • Intense pressure in the rectum
  • Low blood pressure
  • Pain in the shoulder area
  • Severe, sharp, and sudden pain in the lower abdomen

Exams and Tests

The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area.

A pregnancy test and vaginal ultrasound will be done.

HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone (quantitative HCG blood test ) can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your doctor may suspect an ectopic pregnancy.

Treatment

Ectopic pregnancy is life-threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life.

You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock, an emergency condition. Treatment for shock may include:

  • Blood transfusion
  • Fluids given through a vein
  • Keeping warm
  • Oxygen
  • Raising the legs

If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube.

If the ectopic pregnancy has not ruptured, treatment may include:

  • Surgery
  • Medicine that ends the pregnancy, along with close monitoring by your doctor

Outlook (Prognosis)

One out of three women who have had one ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again.

The likelihood of a successful pregnancy after an ectopic pregnancy depends on:

  • The woman's age
  • Whether she has already had children
  • Why the first ectopic pregnancy occurred

When to Contact a Medical Professional

Call your doctor or nurse if you have:

  • Abnormal vaginal bleeding
  • Lower abdominal or pelvic pain

Prevention

Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include:

  • Practicing safer sex by taking steps before and during sex, which can prevent you from getting an infection
  • Getting early diagnosis and treatment of all infections caused by sexual relations (STDs)
  • Stopping smoking

References

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.94: Medical management of ectopic pregnancy. Obstet Gynecol. 2008;111:1479–1485. Reaffirmed 2012.

Barnhart KT. Ectopic pregnancy. N Engl J Med. 2009;361:379-387.

Houry DE, Salhi BA. Acute complications of pregnancy. In Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 178.

Lobo RA. Ectopic pregnancy: Etiology, pathology, diagnosis, management, fertility prognosis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Elsevier Mosby; 2012:chap 17.

Updated: 2/24/2014

Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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