Illness & Conditions - Health Conditions
What is an ectopic pregnancy?
In a normal pregnancy, a fertilized egg travels through a fallopian tube to the uterus . The egg attaches in the uterus and starts to grow. But in an ectopic pregnancy , the fertilized egg attaches (or implants) someplace other than the uterus, most often in the fallopian tube. (This is why it is sometimes called a tubal pregnancy.) In rare cases, the egg implants in an ovary, the cervix, or the belly.
There is no way to save an ectopic pregnancy. It cannot turn into a normal pregnancy. If the egg keeps growing in the fallopian tube, it can damage or burst the tube and cause heavy bleeding that could be deadly. If you have an ectopic pregnancy, you will need quick treatment to end it before it causes dangerous problems.
What causes an ectopic pregnancy?
An ectopic pregnancy is often caused by damage to the fallopian tubes. A fertilized egg may have trouble passing through a damaged tube, causing the egg to implant and grow in the tube.
Things that make you more likely to have fallopian tube damage and an ectopic pregnancy include:
Some medical treatments can increase your risk of ectopic pregnancy. These include:
What are the symptoms?
In the first few weeks, an ectopic pregnancy usually causes the same symptoms as a normal pregnancy, such as a missed menstrual period, fatigue, nausea, and sore breasts.
The key signs of an ectopic pregnancy are:
If you think you are pregnant and you have these symptoms, see your doctor right away.
How is an ectopic pregnancy diagnosed?
A urine test can show if you are pregnant. To find out if you have an ectopic pregnancy, your doctor will likely do:
How is it treated?
The most common treatments are medicine and surgery. In most cases, a doctor will treat an ectopic pregnancy right away to prevent harm to the woman.
Medicine can be used if the pregnancy is found early, before the tube is damaged. In most cases, one or more shots of a medicine called methotrexate will end the pregnancy. Taking the shot lets you avoid surgery, but it can cause side effects. You will need to see your doctor for follow-up blood tests to make sure the shot worked.
For a pregnancy that has gone beyond the first few weeks, surgery is safer and more likely to work than medicine. If possible, the surgery will be laparoscopy (say "lap-uh-ROSS-kuh-pee"). This type of surgery is done through one or more small cuts (incisions) in your belly. If you need emergency surgery, you may have a larger incision.
What can you expect after an ectopic pregnancy?
Losing a pregnancy is always hard, no matter how early it happened. Take time to grieve your loss, and get the support you need to make it through this time.
You could be at risk for depression after an ectopic pregnancy. If you have symptoms of depression that last for more than a couple of weeks, be sure to tell your doctor so you can get the help you need.
It is common to worry about your fertility after an ectopic pregnancy. Having an ectopic pregnancy does not mean that you can't have a normal pregnancy in the future. But it does mean that:
If you get pregnant again, be sure your doctor knows that you had an ectopic pregnancy before. Regular testing in the first weeks of pregnancy can find a problem early or let you know that the pregnancy is normal.
Frequently Asked Questions
Fallopian tube damage is a common cause of ectopic pregnancy. A fertilized egg can become caught in the damaged area of a tube and begin to grow there. Some ectopic pregnancies develop without any known cause.
Common causes of fallopian tube damage that may lead to an ectopic pregnancy include:
Although pregnancy is rare after a tubal ligation or with an intrauterine device (IUD), those pregnancies that do develop have an increased chance of being ectopic. 2
An early ectopic pregnancy often feels like a normal pregnancy. A woman with an ectopic pregnancy may experience common signs of early pregnancy, such as:
First signs of an ectopic pregnancy may include:
As an ectopic pregnancy progresses, though, other symptoms may develop, including:
Normally, at the beginning of a pregnancy, the fertilized egg travels from the fallopian tube to the uterus , where it implants and grows. But in about 2% of diagnosed pregnancies, the fertilized egg attaches to an area outside of the uterus, which results in an ectopic pregnancy (also known as a tubal pregnancy or an extrauterine pregnancy). 3
An ectopic pregnancy cannot support the life of a fetus for very long. But an ectopic pregnancy can grow large enough to rupture the area it occupies, cause heavy bleeding, and endanger the mother. A woman with signs or symptoms of an ectopic pregnancy requires immediate medical care.
An ectopic pregnancy can develop in different locations . In most ectopic pregnancies, the fertilized egg has implanted in a fallopian tube.
In rare cases:
Complications of ectopic pregnancy
Ectopic pregnancy can damage the fallopian tube, which can make it difficult to become pregnant in the future.
Ectopic pregnancies are usually detected early enough to prevent deadly complications such as severe bleeding. A ruptured ectopic pregnancy requires emergency surgery to prevent heavy bleeding into the abdomen. The affected tube is partially or fully removed. For more information, see Surgery.
What Increases Your Risk
Factors that can increase your risk of having an ectopic pregnancy include: 1
Medical treatments and procedures that can increase your risk of having an ectopic pregnancy include:
Ectopic pregnancy has been linked to the use of medicine used to make the ovary release multiple eggs ( superovulation ). Experts do not yet know whether this is because many women using it already have fallopian tube damage or because of the medicine itself. 1
If you become pregnant and are at high risk for ectopic pregnancy, you will be closely watched. Doctors do not always agree about which risk factors are serious enough to watch closely. But research suggests that risk is serious enough if you have had a tubal surgery or an ectopic pregnancy before, had DES exposure before birth, have known fallopian tube problems, or have a pregnancy with an intrauterine device (IUD) in place. 1
When To Call a Doctor
If you are pregnant, be alert to the symptoms that may mean you have an ectopic pregnancy, especially if you are at risk. If you have symptoms of an ectopic pregnancy or you are being treated for an ectopic pregnancy, avoid strenuous activity until your symptoms have been evaluated by a doctor.
Call 911 or other emergency services immediately if:
Call your doctor now or seek immediate medical care if:
Who to see
The following health professionals can evaluate you for an ectopic pregnancy:
A diagnosed ectopic pregnancy is treated by a gynecologist .
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
Most ectopic pregnancies can be detected using a pelvic exam, ultrasound, and blood tests. If you have symptoms of a possible ectopic pregnancy, you will have:
Sometimes a surgical procedure using laparoscopy is used to look for an ectopic pregnancy. An ectopic pregnancy after 5 weeks can usually be diagnosed and treated with a laparoscope. But laparoscopy is not often used to diagnose a very early ectopic pregnancy, because ultrasound and blood pregnancy tests are very accurate.
Follow-up testing after treatment
During the week after treatment for an ectopic pregnancy, your hCG (human chorionic gonadotropin) blood levels are tested several times. Your doctor will look for a drop in hCG levels, which is a sign that the pregnancy is ending (hCG levels sometimes rise during the first few days of treatment, then drop). In some cases, hCG testing continues for weeks to months until hCG levels drop to a low level.
What to think about
If you become pregnant and are at high risk for an ectopic pregnancy, you will be closely monitored. Doctors do not always agree about which risk factors are serious enough to watch closely. But research suggests that risk is serious enough if you have had a tubal surgery or an ectopic pregnancy before, had DES exposure before birth, have known fallopian tube problems, or have a pregnancy with an intrauterine device (IUD) in place. 1
A urine pregnancy test—including a home pregnancy test—can accurately diagnose a pregnancy but cannot detect whether it is an ectopic pregnancy. If a urine pregnancy test confirms pregnancy and an ectopic pregnancy is suspected, further blood testing or ultrasound is needed to diagnose an ectopic pregnancy.
In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. The decision about which treatment to use depends on how early the pregnancy is detected and your overall condition. For an early ectopic pregnancy that is not causing bleeding, you may have a choice between using medicine or surgery to end the pregnancy.
Using methotrexate to end an ectopic pregnancy spares you from an incision and general anesthesia . But it does cause side effects and can take several weeks of hormone blood-level testing to make sure that treatment has worked. Methotrexate is most likely to work:
If you have an ectopic pregnancy that is causing severe symptoms, bleeding, or high hCG levels, surgery is usually needed. This is because medicine is not likely to work and a rupture becomes more likely as time passes. When possible, laparoscopic surgery that uses a small incision is done. For a ruptured ectopic pregnancy , emergency surgery is needed.
For an early ectopic pregnancy that appears to be naturally miscarrying (aborting) on its own, you may not need treatment. Your doctor will regularly test your blood to make sure that your pregnancy hormone (hCG, or human chorionic gonadotropin) levels are dropping. This is called expectant management.
Ectopic pregnancies can be resistant to treatment.
What to think about
Surgery versus medicine
Surgery may be your only treatment option if you have internal bleeding.
You cannot prevent ectopic pregnancy, but you can prevent serious complications with early diagnosis and treatment. If you have one or more risk factors for ectopic pregnancy, you and your doctor can closely monitor your first weeks of a pregnancy.
If you smoke, quit to lower your risk of ectopic pregnancy. Women who smoke or who used to smoke have higher rates of ectopic pregnancy. The more you now smoke, the higher your risk is. 1
Using safer sex practices, such as using a condom every time you have sex helps protect you from sexually transmitted infections (STIs) that can lead to pelvic inflammatory disease (PID) . PID is a common cause of scar tissue in the fallopian tubes, which can cause ectopic pregnancy.
If you are at risk for having an ectopic pregnancy and you think you may be pregnant, use a home pregnancy test. If it is positive, be sure to have a confirmation test done by a doctor, especially if you are concerned about having an ectopic pregnancy.
If you are receiving methotrexate treatment to end an ectopic pregnancy, you may experience side effects from the medicine. See these tips for managing methotrexate treatment to minimize these side effects.
If you experience an ectopic pregnancy loss, no matter how early in a pregnancy, expect that you and your partner will need time to grieve. It is also possible to develop depression from the hormonal changes after a pregnancy loss. If you have symptoms of depression that last for more than a couple of weeks, be sure to call your doctor or a psychologist, clinical social worker, or licensed mental health counselor.
You can contact a support group, read about the experiences of other women, and talk to friends, a counselor, or a member of the clergy. These things may help you and your family deal with a pregnancy loss.
Concerns about future pregnancy
If you have had an ectopic pregnancy, you may worry about your chances of having a healthy or ectopic pregnancy in the future. Your risk factors and any fallopian tube damage you may have will impact your future risk and your ability to become pregnant. Your doctor can answer your questions based on your risk factors.
Medicine can only be used for early ectopic pregnancies that have not ruptured. Depending on where the ectopic growth is and what type of surgery would otherwise be used, medicine may be less likely than surgical treatment to cause fallopian tube damage.
Medicine is most likely to work when an early ectopic pregnancy is not causing bleeding and:
For an ectopic pregnancy that is more developed, surgery is a safer and more dependable treatment.
Methotrexate is used to stop the growth of an early ectopic pregnancy. It can also be used after surgical ectopic treatment to ensure that all ectopic cell growth has stopped.
What to think about
Methotrexate treatment is usually the first choice for ending an early ectopic pregnancy. If the pregnancy is further along, surgery is safer and more likely than medicine to be effective.
Routine follow-up blood tests are needed for days to weeks after the medicine is injected.
Methotrexate can cause unpleasant side effects, such as nausea, indigestion, and diarrhea. For information about how to minimize side effects, see these tips for managing methotrexate treatment.
Methotrexate versus surgery
If your ectopic pregnancy is not too far advanced and has not ruptured, methotrexate may be a treatment option for you. Successful methotrexate treatment of an early ectopic pregnancy avoids the risks of surgery, may be less likely to damage the fallopian tube than surgery, and is more likely to preserve your fertility.
If you are not concerned with preserving fertility, surgery for an ectopic pregnancy is faster than methotrexate treatment and will likely cause less bleeding.
At any stage of development, surgical removal of an ectopic growth and/or the fallopian tube section where it has implanted is the fastest treatment for ectopic pregnancy. Surgery may be your only treatment option if you have internal bleeding. When possible, surgery is done through a small incision using laparoscopy. This type of surgery usually has a short recovery period.
An ectopic pregnancy can be removed from a fallopian tube by using salpingostomy or salpingectomy.
Both salpingostomy and salpingectomy can be done either through a small incision using laparoscopy or through a larger open abdominal incision ( laparotomy ). Laparoscopy takes less time than laparotomy. And the hospital stay is shorter. 4 But for an abdominal ectopic pregnancy or an emergency tubal ectopic removal, a laparotomy is usually required.
What to think about
When an ectopic pregnancy is located in an unruptured fallopian tube, every attempt is made to remove the pregnancy without removing or damaging the tube.
Emergency surgery is needed for a ruptured ectopic pregnancy.
Your future fertility and your risk of having another ectopic pregnancy will be affected by your own risk factors. These can include smoking, use of assisted reproductive technology (ART) to get pregnant, and how much fallopian tube damage you have.
As long as you have one healthy fallopian tube, salpingostomy (small tubal slit) and salpingectomy (part of a tube removed) have about the same effect on your future fertility. But if your other tube is damaged, your doctor may try to do a salpingostomy. This may improve your chances of getting pregnant in the future. 2
Ectopic pregnancy is a potentially life-threatening condition that must be treated with surgery, medicine, or frequent testing. Alternative treatments are not appropriate for this condition.
Other Places To Get Help
Last Revised: May 6, 2011
Speroff L, Fritz MA (2005). Ectopic pregnancy. In Clinical Gynecologic Endocrinology and Infertility, 7th ed., pp. 1275–1302. Philadelphia: Lippincott Williams and Wilkins.
Farquhar CM (2005). Ectopic pregnancy. Lancet, 366: 583–591.
American College of Obstetricians and Gynecologists (2008, reaffirmed 2012). Medical management of ectopic pregnancy. ACOG Practice Bulletin No. 94. Obstetrics and Gynecology, 111(6): 1479–1485.
Cunningham FG, et al. (2010). Ectopic pregnancy. In Williams Obstetrics, 23rd ed., pp. 238–256. New York: McGraw-Hill.
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