PREGNANCY-RELATED CONDITIONS
ECTOPIC PREGNANCY
An ectopic pregnancy is a pregnancy that matures outside of, instead of inside the uterus. Most of ectopic pregnancies occur in the fallopian tubes, although some can occur in the ovaries or the abdominal cavity instead. This is because the egg matures in the ovaries, from where it is released into the abdominal cavity (ovulation). Subsequently, the fallopian tubes take up the egg, which then slowly migrates down the fallopian tubes into the uterus. During a normal pregnancy, the egg is fertilized in the fallopian tubes, and then continues to migrate into the uterus, where it implants itself into the uterine lining (mucous coat covering the uterine wall).
When the ovaries are congested (clogged up) for some reason, such as infection or some other injury to the reproductive organs, the egg cannot travel down its normal path into the uterus. This is of no further significance so long as the egg is not fertilized, in which case it will simply be absorbed and metabolized by the body - often without any noticeable symptoms to you. However, if the egg does become fertilized, but is unable to migrate to the uterus, it will implant itself at whatever site it is located - usually the fallopian tubes, but sometimes also the abdominal cavity or the ovaries.
Despite the fact that an ectopic pregnancy is technically termed a pregnancy, because an egg gets fertilized and implanted, it is not a condition that can lead to the normal development of a fetus. The embryo in an ectopic pregnancy is not viable, because it cannot grow to term in any place that does not have the uterus' unique ability to expand and accommodate its rapidly increasing size. To the contrary - an ectopic pregnancy is not only unsustainable for the embryo, it is also potentially life-threatening for the mother. Therefore, an ectopic pregnancy must be terminated as soon as possible, before the Fallopian tubes ruptures (usually between weeks 6 and 16). Treatments for ectopic pregnancies vary depending on the stage of the pregnancy and condition of the mother (see below).
Ectopic pregnancies are not as rare as might be expected. In fact, about 1% to 2% of pregnancies (1 to 2 out of 100) are ectopic pregnancies. If you are concerned about ectopic pregnancy, read through the symptoms an risk factors below and do not delay spelling with your doctor! To diagnose your ectopic pregnancy, our doctor will likely have to perform an ultrasound.
Risk Factors
Symptoms
​Before the fallopian tube has ruptured
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Initially symptoms often mimic those of a normal pregnancy: Morning sickness, breast tenderness, positive pregnancy test
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Bloating and pain in different areas of the trunk depending on where internal bleeding occurs and collects
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Mild abdominal pain and cramping
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Light vaginal bleeding
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Lower back pain
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After the Fallopian tube has ruptured
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Low blood pressure
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Sharp, severe abdominal pain
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Heavy bleeding (although not necessarily)
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Rectal pressure similar to a perceived bowel movement
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Lightheadedness, fainting and shock due to internal bleeding
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Smoking
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Endometriosis
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Previous ectopic pregnancy
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Uterine contraceptive implants, i.e. intrauterine devices (IUD)
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Infertility and use of assisted reproductive technology, such as IVF
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Surgery on the fallopian tubes or other reproductive organs, such as tubal ligation (getting your tubes tied for contraception)
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Infection or inflammation of the fallopian tubes or other reproductive organs, for instance due to sexually transmitted disease (STD) or pelvic inflammatory disease (PID) causing scar tissue formation
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​Advanced maternal age (> 35)
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Previous abortion(s)
Treatments
Before the fallopian tube has ruptured
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Methotrexate (medication): Methotrexate is a chemotherapeutic and immunosuppressant agent (drug) that causes termination (abortion) of the ectopic pregnancy by inhibiting cell growth of the fetus. It can be given orally, but is mostly given by injection. One or two injections might be necessary depending on the effectiveness of the first injection. If this treatment works properly, the fetal cells stop replicating and are subsequently aborted through your body's own metabolism. This can take as long as 4 to 6 weeks. It is therefore important to follow up regularly with your doctor during this time. Amongst other things, your doctor must make sure that your levels of the pregnancy hormone Human Chorionic Gonadotropin (HCG) are going down after the treatment, which is a marker that your ectopic pregnancy has been successfully terminated and no fetal cells remain in the fallopian tube. Because methotrexate is a strong and even aggressive drug (it is also used for treatment of a variety of cancers), women with certain preexisting chromic conditions may not be eligible for this
treatment. Moreover, it can come with a host of side-effects such as abdominal pain, vaginal bleeding, nausea, vomiting, dizziness and fainting. Nonetheless, if you are eligible, methotrexate is a good treatment option, because it saves your Fallopian tube and does not require surgery. -
Surgical removal (either laparoscopic and abdominal) of the egg while leaving the fallopian tube intact (salpingostomy): You can also opt to have the fetal tissue surgically removed from your fallopian tube (or ovary or abdominal cavity). If the ectopic pregnancy is discovered at a relatively early time and no major scarring or other damage has been done to the fallopian tube, your doctor might be able to save the fallopian tube and remove the fetal tissue alone. This can be done both minimally invasive (laparoscopically) and through an abdominal incision. Each procedure has its advantages and disadvantages. A laparoscopic procedures makes small incisions in your naval or abdomen through which a microscope and surgical instruments are inserted into your pelvic cavity. This avoids later issues from
major scarring but bears a higher risk of bowel and blood vessel perforation. -
Surgical removal (either laparoscopic and abdominal) of the egg and fallopian tube (salpingectomy): If your fallopian tube is already too adages from the ectopic pregnancy, it may be necessary to remove the fallopian tube (and/or surrounding structures) together with the ectopic fetal tissue. However, this does not necessarily prevent you from having a future pregnancy so long as your other fallopian tube is still intact.
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After the fallopian tube has ruptured
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Surgical removal (either laparoscopic and abdominal) of the egg and fallopian tube: If your Fallopian tube has already burst, it must be removed to avoid major bleeding and infection in your abdominal cavity. On in very rare cases can a ruptured fallopian tube be saved. However, this does not necessarily mean that you won't be able to have another healthy pregnancy so long as your second fallopian tube is still intact.
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