Ectopic Pregnancy

What is ectopic pregnancy?
An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies—more than 90%—occur in a fallopian tube. As the pregnancy grows, it can cause the tube to burst (rupture). A rupture can cause major internal bleeding. This can be a life-threatening emergency that needs immediate surgery.

What are the risk factors for ectopic pregnancy?
The risk factors for ectopic pregnancy include the following:

  • Previous ectopic pregnancy
  • Prior fallopian tube surgery
  • Previous pelvic or abdominal surgery
  • Certain sexually transmitted infections (STIs)
  • Pelvic inflammatory disease
  • Endometriosis

Other factors that may increase a woman’s risk of ectopic pregnancy include:

  • cigarette smoking
  • age older than 35 years
  • history of infertility
  • use of assisted reproductive technology, such as in vitro fertilization (IVF)

About one half of all women who have an ectopic pregnancy do not have known risk factors. Sexually active women should be alert to changes in their bodies, especially if they experience symptoms of an ectopic pregnancy.

What are the symptoms of ectopic pregnancy?
At first, an ectopic pregnancy may feel like a typical pregnancy with some of the same signs, such as a missed menstrual period, tender breasts, or an upset stomach. Other signs may include:

  • abnormal vaginal bleeding
  • low back pain
  • mild pain in the abdomen or pelvis
  • mild cramping on one side of the pelvis

At this stage, it may be hard to know if you are experiencing a typical pregnancy or an ectopic pregnancy. Abnormal bleeding and pelvic pain should be reported to your obstetrician–gynecologist (ob-gyn) or other health care professional.

As an ectopic pregnancy grows, more serious symptoms may develop, especially if a fallopian tube ruptures. Symptoms may include the following:

  • Sudden, severe pain in the abdomen or pelvis
  • Shoulder pain
  • Weakness, dizziness, or fainting

A ruptured fallopian tube can cause life-threatening internal bleeding. If you have sudden, severe pain; shoulder pain; or weakness, you should go to an emergency room.

How is ectopic pregnancy diagnosed?
If you do not have the symptoms of a fallopian tube rupture but your ob-gyn or other health care professional suspects you may have ectopic pregnancy, he or she may perform a pelvic exam
perform an ultrasound exam to see where the pregnancy is developing
test your blood for a pregnancy hormone called human chorionic gonadotropin (hCG)

How is ectopic pregnancy treated?
An ectopic pregnancy cannot move or be moved to the uterus, so it always requires treatment. There are two methods used to treat an ectopic pregnancy: 1) medication and 2) surgery. Several weeks of follow-up are required with each treatment.

What medication is used to treat ectopic pregnancy?
The most common drug used to treat ectopic pregnancy is methotrexate. This drug stops cells from growing, which ends the pregnancy. The pregnancy then is absorbed by the body over 4–6 weeks. This does not require the removal of the fallopian tube.

When is medication used to treat ectopic pregnancy?
Methotrexate may be used if the pregnancy has not ruptured a fallopian tube. Several factors go into the decision to use methotrexate. One of the most important factors is your ability to follow up with blood tests that check your blood levels of hCG. You will not be able to use methotrexate if you are breastfeeding or have certain health problems.

How is methotrexate given?
Methotrexate often is given by injection in one dose. Before you take methotrexate, blood tests will be done to measure the level of hCG and the functions of certain organs. If hCG levels have not decreased enough after the first dose, another dose of methotrexate may be recommended. You will have careful follow-up over time until hCG is no longer found in your blood.

When is surgery used to treat ectopic pregnancy?
If the ectopic pregnancy has ruptured a tube, emergency surgery is needed. Sometimes surgery is needed even if the fallopian tube has not ruptured. In these cases, the ectopic pregnancy can be removed from the tube, or the entire tube with the pregnancy can be removed.

How is surgery performed?
Surgery typically is done with laparoscopy. This procedure uses a slender, lighted camera that is inserted through small cuts in the abdomen. It is done in a hospital with general anesthesia.

What are possible side effects and risks of taking methotrexate?
Taking methotrexate can have some side effects. Most women have some abdominal pain. Vaginal bleeding or spotting also may occur. Other side effects may include

  • nausea
  • vomiting
  • diarrhea
  • dizziness

It is important to follow up with our office until your treatment with methotrexate is complete. The risk of a fallopian tube rupture does not go away until your treatment is over. Seek care right away if you have symptoms of a rupture, including:

  • sudden abdominal pain
  • shoulder pain
  • weakness

Is there anything I should avoid while taking methotrexate?

Yes, during treatment with methotrexate you should avoid the following:

  • Heavy exercise
  • Sexual intercourse
  • Alcohol
  • Vitamins and foods that contain folic acid, including fortified cereal, enriched bread and pasta, peanuts, dark green leafy vegetables, orange juice, and beans
  • Prescription pain medication and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medications can affect the way methotrexate works in the body.
  • Foods that produce gas, which can cause discomfort and mask the pain of a possible rupture of a fallopian tube
  • Prolonged exposure to sunlight. Methotrexate can cause sun sensitivity.

What are the possible side effects and risks of surgery?
At your pre-operative consultation, we will talk with you about the possible side effects and risks of surgery for ectopic pregnancy. These may include:

  • pain
  • fatigue
  • bleeding
  • infection
  • salpingectomy – removal of fallopian tube(s)

How will I feel after treatment?
Whether you were treated with methotrexate or surgery, you may feel tired for several weeks while you recover. You may feel abdominal discomfort or pain. If you have pain that does not respond to over-the-counter medication, please advise our office.

It can take time for the level of hCG in your body to drop after treatment for an ectopic pregnancy. You may continue to feel pregnant for a while. It may take a few cycles for your periods to return to normal.

How can I get emotional support after an ectopic pregnancy?
For some women, ectopic pregnancy can be traumatic. You may be dealing with many emotions after an ectopic pregnancy, even if you were not planning to become pregnant. Take time to work through your feelings. Counseling may be helpful. At your request, we are happy to recommend a counselor. Online forums also can be a place to get support from other women who have had ectopic pregnancies.

Can an ectopic pregnancy affect future pregnancies?
Once you have had an ectopic pregnancy, you are at higher risk of having another one. During future pregnancies, be alert for signs and symptoms of ectopic pregnancy until we confirm the next pregnancy is growing in the right place.