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.

To confirm a diagnosis, your doctor will perform a blood test to check your level of the pregnancy hormone, human chorionic gonadotropin (hCG). If it is high enough to suggest a pregnancy, but not as high as it should be at your stage, the pregnancy may be ectopic. Your doctor may also perform a vaginal exam to look for a mass or enlarged fallopian tube or to confirm vaginal tenderness, all of which indicate an ectopic pregnancy.

An ultrasound can also confirm an ectopic pregnancy. However, in most cases, the embryo dies early in the process and is too small for the sonographer to find. In this case, he or she will usually look for a swollen fallopian tube and may see blood clots as well as any remaining tissue from the embryo.

Your doctor will treat an ectopic pregnancy depending on the size of the embryo, its location, and whether you want to be able to conceive again. If it is discovered early, your doctor may give you an injection of methotrexate, which dissolves the fertilized egg and allows your body to reabsorb it, thereby minimizing scarring of your pelvic organs. However, if the pregnancy is further along, you will probably need surgery to remove the embryo. If you're in stable condition and the embryo is small enough, it can be removed using laparoscopic surgery, which involves a small incision and general anesthesia. If you have extensive scar tissue, heavy bleeding, or if the embryo is too large, it must be removed with major abdominal surgery. Regardless of treatment, your doctor will want to see you regularly afterward to make sure your hCG levels return to zero, which may take up to 12 weeks. If your hCG levels remain elevated, it could indicate that some ectopic tissue was not removed.

Your ability to conceive after an ectopic pregnancy depends on how early the ectopic was discovered and removed, and the damage to your fallopian tube. Approximately 30 percent of women who have had ectopic pregnancies will have fertility issues in the future.