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Published: Sept. 26, 2008
Updated: Sept. 8, 2010
An ectopic pregnancy is a pregnancy that has occurred outside of the uterine cavity. The fallopian tube is the most common site for ectopic pregnancies to occur.
These pregnancies must be discontinued by medical or surgical means as they can represent a significant health risk to the woman.
The cause of ectopic pregnancies will continue to require scientific research for some time to come. What can be discussed clinically are risk factors for ectopic pregnancy.
Since the fallopian tube is the most common site for implantation outside of the uterus, any damage to the fallopian tube can increase a woman's risk for ectopic pregnancy.
Infection of the fallopian tube, surgery on the tube, or scar tissue involving the fallopian tube can all increase the risk of ectopic pregnancy.
Women who have had previous ectopic pregnancies without having their affected tube removed may have scar tissue present that can increase their chances of an ectopic pregnancy.
Often women with significant damage to their fallopian tubes will be recommended to undergo in vitro fertilization (IVF). Ectopic pregnancies are not likely with IVF, though they are possible.
Most women with ectopic pregnancies experience pain and vaginal bleeding. The pain tends to intensify with time and is most often off to one side of the abdomen.
Some ectopic pregnancies can be discovered before they become symptomatic. There are not any specific symptoms that are purely suggestive of an ectopic pregnancy.
Pelvic infections, ovarian torsion, appendicitis, and other pelvic pains of unknown origin must be excluded from the diagnosis.
The diagnosis of an ectopic pregnancy relies on the presence of a positive pregnancy test in combination with one or more other factors.
Visible evidence of a pelvic mass on ultrasound, absence of an intrauterine pregnancy on ultrasound, blood in the abdomen, and severe pain increase the physician’s suspicion for an ectopic pregnancy.
The quantitative Human Chorionic Gonadotropin (QHCG) value is often used as a guide to assist with investigating a possible ectopic pregnancy. If the QHCG value is significantly elevated and there is no evidence of an intrauterine pregnancy then there is most likely an ectopic pregnancy.
Sometimes a dilation and curettage (D&C) can be done and if there is not any evidence for a pregnancy in the uterine scrapings, the surgeon will continue with a laparoscopic procedure to look for an ectopic pregnancy.
Ectopic pregnancies can be treated medically or surgically.
The medical treatment involves the injection of methotrexate. This is a chemotherapy drug that can effectively treat ectopic pregnancy. Stringent criteria must be met to qualify an ectopic pregnancy for use of methotrexate in order to reduce the risk of failed therapy or worsening symptoms.
If methotrexate is used, women will have blood drawn on the day the medication is given and on day four and day seven following administration of the drug. Women may experience an increase in pain after the medication is given as well as nausea. Sometimes a second dose of methotrexate is required.
Ectopic pregnancies can also be treated surgically. In very emergent circumstances a laparotomy (incision into the abdomen) is performed. In most cases, laparoscopy can be used to locate and remove the ectopic pregnancy.
A salpingotomy is an incision in the fallopian tube through which the ectopic can be removed. This is done in an attempt to save the fallopian tube. If the damage to the tube is too extensive or the salpingotomy fails, a salpingectomy can be performed. This is the complete removal of the fallopian tube.
On occasion, the ectopic pregnancy will be located at the extreme end of the fallopian tube and can be removed without damage to the tube. Ectopic pregnancies occurring in other locations may further complicate the surgery.
There are two main factors that need to be discussed with regard to future fertility.
A damaged fallopian tube may increase a woman's risk for ectopic pregnancy.
If the tube is significantly damaged then the risk for ectopic may warrant to removal of the tube. Having one tube removed does not appreciably decrease a woman's chance for becoming pregnant.
Women no longer having a "good" tube on either side will likely be counseled to consider IVF. Feel free to discuss your individual situation with your physician.
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