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Ectopic pregnancy

Ultrasound, normal fetus - foot
Ectopic pregnancy

Definition

An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother.

Alternative Names

Tubal pregnancy; Cervical pregnancy; Tubal ligation-ectopic pregnancy

Causes

In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include:

The following also increase risk of an ectopic pregnancy:

Sometimes the cause is unknown. Hormones may play a role.

The most common site for an ectopic pregnancy is within one of the two fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix.

An ectopic pregnancy can occur even if you use birth control.

Symptoms

You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include:

If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:

Exams and Tests

The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area.

A pregnancy test and vaginal ultrasound will be done.

HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone (quantitative HCG blood test) can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your doctor may suspect an ectopic pregnancy.

Treatment

Ectopic pregnancy is life-threatening. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life.

You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock, an emergency condition. Treatment for shock may include:

If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube.

If the ectopic pregnancy has not ruptured, treatment may include:

Outlook (Prognosis)

One out of three women who have had one ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again.

The likelihood of a successful pregnancy after an ectopic pregnancy depends on:

When to Contact a Medical Professional

Call your doctor or nurse if you have:

Prevention

Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include:

References

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.94: Medical management of ectopic pregnancy. Obstet Gynecol. 2008;111:1479–1485. Reaffirmed 2012.

Barnhart KT. Ectopic pregnancy. N Engl J Med. 2009;361:379-387.

Houry DE, Salhi BA. Acute complications of pregnancy. In Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, Pa: Mosby Elsevier; 2013:chap 178.

Lobo RA. Ectopic pregnancy: Etiology, pathology, diagnosis, management, fertility prognosis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Elsevier Mosby; 2012:chap 17.


Review Date: 2/24/2014
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.