Ectopic Pregnancies

Ectopic pregnancies, or those outside the uterus, occur in approximately one in 50 pregnancies. When a fertilized egg is unable to travel down to the uterus, it may implant in another location such as the fallopian tubes (called a tubal pregnancy) the ovaries, in the abdomen, or on the cervix.

The number of ectopic pregnancies in the U.S. has increased dramatically in the last 20 years, largely due to the rising rate of sexually transmitted infections, such as chlamydia, which often lead to pelvic inflammatory disease (PID) and scarring of the fallopian tubes. Endometriosis is also a common cause of blocked tubes, as are birth defects or abnormal growths, which can change the shape of the fallopian tube and interfere with the egg's progress. There are some identifiable risk factors for ectopic pregnancy, including women who:

• are 35 to 44 years old

• have had Pelvic Inflammatory Disease

• have had a previous ectopic pregnancy

• have had surgery on a fallopian tube

• have had infertility problems or medication to stimulate ovulation

• use certain birth control methods such as an IUD, progesterone-only oral contraceptives, or if you used the morning-after pill.

You may also be at heightened risk if your mother took the drug DES while she was pregnant with you. DES is a synthetic form of estrogen that was given to women in the 1960s to prevent miscarriage, but it was later found to cause cancer, infertility, and miscarriage.

A few studies have also shown smoking and regular douching also increase the risk for ectopic pregnancies. The greatest risk factor for an ectopic pregnancy is a history of prior ectopic pregnancies. The recurrence rate is 15 percent after the first ectopic pregnancy, and 30 percent after the second. However, many women without any risk factors can still develop an ectopic pregnancy.

Ectopic pregnancies are usually discovered at about six or seven weeks when the woman develops symptoms, although some women notice symptoms as early as four weeks; in some asymptomatic cases, the ectopic is not discovered until a routine first trimester ultrasound. Ectopic pregnancies don't always register on a home pregnancy test, so if you are experiencing symptoms, don't wait to contact your doctor.

Self-diagnosing an ectopic pregnancy can be difficult because the symptoms are often identical to those of a normal early pregnancy, such as missed periods, breast tenderness, nausea, vomiting, or frequent urination. However, pain is usually the most common identifiable symptom. Most women feel pain in their abdomen, pelvis, or even in their shoulder or neck in certain extreme cases. Additional symptoms include vaginal spotting or bleeding, dizziness or fainting, low blood pressure, and lower back pain.

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