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Alternative names Return to top
Tubal pregnancy; Cervical pregnancy; Abdominal pregnancyDefinition Return to top
Ectopic pregnancy occurs when a fertilized egg implants in tissue outside of the uterus, and the placenta and fetus begin to develop there. The most common site is within a fallopian tube. However, ectopic pregnancies can rarely occur in the ovary, the abdomen, and in the lower portion of the uterus (the cervix).Causes, incidence, and risk factors Return to top
Ectopic pregnancies are usually caused by conditions that obstruct or slow the passage of a fertilized ovum (egg) through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube. Ectopic pregnancy may also be caused by failure of the zygote (the cell formed after the egg is fertilized) to move down the tube and into the uterus.
Most cases are a result of scarring caused by previous tubal infection or tubal surgery. Up to 50% of women with ectopic pregnancies have a medical history of salpingitis or PID (pelvic inflammatory disease). Some ectopic pregnancies can be traced to congenital tubal abnormalities, endometriosis, tubal scarring and kinking caused by a ruptured appendix, or scarring caused by previous pelvic surgery and prior ectopic pregnancies. In a few cases, the cause is unknown.
On occasion, a woman will become pregnant after elective tubal sterilization. The risk of an ectopic pregnancy occurring in this situation may reach 60%. Women who have had surgery to reverse previous tubal sterilization in order to become pregnant also have an increased risk of ectopic pregnancy when reversal is successful.
The administration of hormones, specifically estrogen and progesterone, can slow the normal movement of the fertilized egg through the tubal epithelium and result in implantation in the tube. Women who become pregnant despite using progesterone-only oral contraceptives have a 5-fold increase in the ectopic pregnancy rate.
Women who become pregnant despite using progesterone-bearing IUDs also have an increased risk of ectopic pregnancy. Ectopic pregnancy rates for those who become pregnant despite non-medicated IUD are 5%, while the rate for medicated IUD users who become pregnant despite the device is 15%. Note that these rates only refer to percents of the tiny proportion of women who become pregnant while using these methods -- they do not refer to women who have once used these methods and later become pregnant, or to the percent of women who become pregnant while using these methods.
The "morning after pill" is associated with a 10-fold increase in risk of this condition when its use fails to prevent pregnancy.
Ectopic pregnancies occur from 1 in every 40 to 1 in every 100 pregnancies. This rate increased four-fold between 1970 and 1992.
Increased risk is associated with women who have a history of salpingitis or PID, tubal surgery of any type (including tubal ligation and its reversal), or prior ectopic pregnancy.
Symptoms Return to top
Signs and tests Return to top
A pelvic examination may reveal uterine adnexal (Fallopian tube or ovary region) tenderness.Treatment Return to top
In the event that pelvic organ rupture has occurred because of the ectopic pregnancy, internal bleeding or hemorrhage may lead to shock. This is the first symptom of nearly 20% of ectopic pregnancies.
Shock is an emergency condition. Initial treatment may be keeping the woman warm, elevating her legs, and administering oxygen. Treatment with intravenous fluids and sometimes a blood transfusion is performed as soon as possible.
Surgical laparotomy is performed to stop the immediate loss of blood (in cases in which rupture has already occurred), or to confirm the diagnosis of ectopic pregnancy, remove the products of conception, and repair surrounding tissue damage. In some cases, removal of the involved fallopian tube may be necessary.
In non-emergency cases, mini-laparotomy or laparoscopy are the most common surgical treatments. Such procedures have similar outcomes. However, they are less invasive and are available at a lower cost because they require minimal hospitalization or outpatient treatment.
Non-surgical (medical) management for ectopic pregnancies without suspected immediate danger of rupture is being implemented in many medical centers . In such cases, methotrexate is administered with careful outpatient monitoring of the woman and serial quantitative HCGs, CBCs, and liver function tests.
Expectations (prognosis) Return to top
About 85% of the women who have experienced one ectopic pregnancy are later able to achieve a normal pregnancy. A subsequent ectopic pregnancy may occur in 10 to 20% of cases. Some women fail to become pregnant again, while others become pregnant and spontaneously abort during the first trimester.
The maternal death rate from ectopic pregnancy in the U.S. has decreased in the last 30 years to less than 0.1%.
Complications Return to top
Calling your health care provider Return to top
A woman who has an early pregnancy, or who thinks she might be pregnant and has symptoms (especially lower abdominal pain or abnormal vaginal bleeding) should notify her health care provider. Ectopic pregnancy can occur in any woman who is fertile and sexually active, regardless of contraceptive use.Prevention Return to top
Forms of ectopic pregnancy, other than tubal, are probably not preventable. However, tubal pregnancies, which make up the majority of ectopic pregnancies, may be prevented in some cases by avoiding those conditions that might cause scarring of the fallopian tubes. Such prevention may include:
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Page last updated: 28 October 2004 |