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Ectopic Pregnancy

An ectopic pregnancy happens when a fertilized egg settles and grows anywhere other than the uterus. The vast majority of ectopic pregnancies occur in the Fallopian tube (98%) although they can also occur in the abdominal cavity, ovary or the cervix. The major health risk with an ectopic pregnancy is rupturing of the Fallopian tube leading to internal bleeding.

Ectopic pregnancyThe greatest risk factor of an ectopic pregnancy is a prior ectopic pregnancy. The recurrence rate is 15% after the first ectopic and 30% after the second. Any disruption of the normal architecture of the Fallopian tubes can be a risk factor for ectopic pregnancy. Previous surgery on the Fallopian tubes such as tubal ligation or reconstructive procedures, can lead to scarring and disruption of the normal anatomy of the tubes and increases the risk of an ectopic pregnancy. Likewise, pelvic infections, congenital abnormalities, endometriosis, fibroid tumors or pelvic scar tissue can narrow the Fallopian tubes and disrupt egg transportation, thereby increasing the chances of an ectopic pregnancy.

What are the Symptoms of an Ectopic Pregnancy?

The classic symptoms of ectopic pregnancy include abdominal pain, the absence of menstrual periods (amenorrhea), and vaginal bleeding.

The woman may not be aware that she is pregnant. These characteristic symptoms occur in ruptured ectopic pregnancies (those accompanied by severe internal bleeding) and non-ruptured ectopic pregnancies. However, while these symptoms are typical for an ectopic pregnancy, they do not mean an ectopic pregnancy is necessarily present and could represent other conditions. In fact, these symptoms also occur with a threatened abortion (miscarriage) in non-ectopic pregnancies.

The symptoms of an ectopic pregnancy typically occur six to eight weeks after the last normal menstrual period, but they may occur later if the ectopic pregnancy is not located in the Fallopian tube. Other symptoms of pregnancy (nausea, breast discomfort, etc.) may also be present in ectopic pregnancy. Weakness, dizziness, and a sense of passing out upon standing can represent serious internal bleeding from a ruptured ectopic pregnancy and require immediate medical attention.

How is an Ectopic Pregnancy Diagnosed?

The first step in the diagnosis is an interview and examination by the doctor. Occasionally, the doctor may feel a tender mass during the pelvic examination. If an ectopic pregnancy is suspected, the combination of blood hormone tests and pelvic ultrasound can usually help to establish the diagnosis. Transvaginal ultrasound is the most useful test to visualize an ectopic pregnancy. In this test, an ultrasound probe is inserted into the vagina, and pelvic images are visible on a monitor. Transvaginal ultrasound can reveal the gestational sac in either a normal (intrauterine) pregnancy or an ectopic pregnancy, but often the findings are not conclusive. Rather than a gestational sac containing a visible embryo, the examination may simply reveal a mass in the area of the Fallopian tubes or elsewhere that is suggestive of, but not conclusive for, an ectopic pregnancy. The ultrasound can also demonstrate the absence of pregnancy within the uterus.

The beta subunit of human chorionic gonadotrophin (beta HCG) blood levels are also used in the diagnosis of ectopic pregnancy. Beta HCG levels normally rise during pregnancy. An abnormal pattern in the rise of this hormone can be a clue to the presence of an ectopic pregnancy.

Early Pregnancy Monitoring After Tubal Reversal

Cautious monitoring is extremely important to reduce the health risks of a tubal pregnancy after tubal surgery. Dr. Storment recommends monitoring your early pregnancy after tubal reversal surgery with quantitative serum HCG assays as soon as you miss a normal menstrual period. He will monitor you with blood work until you are far enough along to see the pregnancy on ultrasound. Because of the risk of ectopic, or tubal, pregnancy (approximately 10-15 percent) following tubal reversal surgery, it is important to notify your obstetrician-gynecologist and Fertility & Women's Health Center of Louisiana as soon as you have a positive pregnancy test. You can use the Pregnancy Report Form to report your pregnancy to us.

How is an Ectopic Pregnancy Treated?

Unfortunately, a tubal pregnancy cannot lead to live birth and must be interrupted and treated. Following the recommended early pregnancy monitoring protocol is the best way to prevent the risk of tubal rupture. If detected early through either ultrasound or HCG testing,  early treatment includes administration of Methotrexate to terminate the pregnancy. After Methotrexate administration, serum HCG levels should be monitored until the HCG level returns to less than 10 mIU/dL.