The term ectopic, means "out of place". When an ectopic pregnancy occurs, the fertilized egg has implanted itself outside the uterus, where it normally spends it's 40 weeks until birth. With 95% of these types of pregnancies, the egg settles in the Fallopian tube, you may have heard the term "tubal pregnancy", same thing.
The cause is often simply a fertilized egg's inability to work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the tube may have partially or entirely blocked it. Pelvic Inflammatory Disease (PID) is the most common of these infections. Endometriosis (when cells that line the uterus detach and grow elsewhere in the body), or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. Rarely, birth defects or abnormal growths can alter the shape of the tube, disrupting the egg's progress.
When this occurs, it never results in a live birth. There is not enough space, or tissue for a baby to normally develop there, and if left too long, the containing organ may burst, which can cause severe bleeding, pain, and can even endanger the woman's life.
The signs and symptoms can be often times missed or mis-taken, because of the resemblance to those of early pregnancy. Missed periods, breast tenderness, nausea, vomiting, or frequent urination, vaginal spotting, or bleeding, dizziness or fainting (caused by blood loss), low blood pressure (also caused by blood loss), and lower back pain. Pain in the pelvis, abdomen, or, in extreme cases, shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain they experience as sharp and stabbing. It may concentrate on one side of the pelvis, and it may come and go or vary in intensity.
If you go to the doctor with these symptoms, and you already know you're pregnant, or if the urine test he or she gives you comes back positive, you'll probably be given a quantitative hCG test to measure the levels of human Chorionic Gonadotropin (hCG), which is a hormone produced by the placenta. HCG appears in the blood and urine as early as 10 days after conception, and its levels double every 2 days for the first 10 weeks of pregnancy. If hCG levels are lower than expected for the stage of pregnancy, it is an indication of ectopic pregnancy.
A pelvic exam is performed to locate the areas causing pain, to check for an enlarged, pregnant uterus, or to find any masses in the abdomen. An ultrasound examination, which shows whether the uterus contains a developing fetus or if masses are present elsewhere in the abdominal area will also be performed. However, the ultrasound may not be able to detect every ectopic pregnancy.
A less commonly performed test, a culdocentesis, may then be used to look for internal bleeding. In this test, a needle is inserted into the space at the very top of the vagina, behind the uterus and in front of the rectum. Any blood or fluid found there likely comes from a ruptured ectopic pregnancy.
Treatment for ectopic pregnancies vary, depending on its size and location and whether the ability to conceive again is desired. An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which dissolves the fertilized egg and allows the body to reabsorb it. This nonsurgical approach minimizes scarring of your pelvic organs. If the pregnancy is further along, surgery will likely be needed.
Laparoscopy, a less invasive surgical procedure sometimes requiring general or regional anesthesia, is also used as treatment. A small incision is made in the lower abdomen and a laparoscope is inserted. It is a long, hollow tube with a lighted end which allows doctors to view internal organs and insert other instruments as needed. Sometimes, a second small abdominal incision is made for the instruments needed. Any damaged organs can also be repaired or removed during this procedure.
Whatever treatment the doctor recommends, regular check-ups afterward are required to make sure hCG levels return to zero, which may take up to 12 weeks. An elevated hCG could mean that some ectopic tissue was missed, which may have to be removed using methotrexate or additional surgery.
Approximately 30% of women who have had ectopic pregnancies will have difficulty becoming pregnant again. The prognosis depends mainly on the extent of the damage and the surgery that was done.
If the fallopian tube has been spared, the chances of a future successful pregnancy are 60%. Even if one fallopian tube has been removed, the chances of having a successful pregnancy with the other tube can be greater than 40%.
Once someone has had one ectopic pregnancy, there is an approximate 15% chance of having another.
Some birth control methods can increase your risk. If you get pregnant while using progesterone-only oral contraceptives, progesterone intrauterine devices (IUDs), or the morning-after pill, you're more likely to have an ectopic pregnancy.
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