Ectopic Pregnancy. V. questions answered

A normal pregnancy begins when a fertilized egg (embryo) attaches to the lining of the uterus (endometrium) where it will then grow and develop. When things don't go according to plan, and the embryo stays in the tube or attaches outside of the endometrium, it is called an ectopic pregnancy.

Any questions?

i. If the embryo doesn't implant in the uterus where can it be?

The most common site of an ectopic pregnancy is the fallopian tube, tubal pregnancy. What happens is that fertilization normally takes place in the tube and then the fertilized egg travels into the uterus. With a tubal pregnancy it stays in the tube and attaches there. The problem is that this structure is not equipped to support a developing and growing pregnancy. Other sites of an ectopic, which can be equally as dangerous, are the ovary, abdominal cavity and the cervix. Although an ectopic is not a viable pregnancy, the tissue grows and can cause significant bleeding to the woman and can be very dangerous and even be life threatening.

ii. How do I know if I have an ectopic pregnancy?

An ectopic will initially present with typical symptoms of early pregnancy (breast tenderness, bloating, nausea, etc.) because the pregnancy hormone HCG is secreted. Once this tissue starts to grow, women can experience vaginal bleeding and some pelvic pain. If the tube begins to leak or rupture, then symptoms can intensify and lead to severe pain and internal bleeding. If you are pregnant and experiencing any of these symptoms, seek medical care right away.

iii. How is the diagnosis of an ectopic made?

Sometimes there are no symptoms. On a routine new obstetrical visit an ultrasound is typically performed. If an intrauterine pregnancy cannot be confirmed (no evidence of the pregnancy within the cavity of the uterus) then there may be suspicion for an ectopic. A sonogram can detect if there is a mass in the region of the tube and ovary. In addition, hormone levels can also be helpful in diagnosing the possibility of an ectopic pregnancy. Women experiencing any symptoms should have an ultrasound to make a qualified diagnosis.

iv. Are some women more at risk for an ectopic than others?

An ectopic can happen without risk factors but there are some risk factors that can make it more susceptible including a past/history of an ectopic pregnancy, pelvic inflammation or infection (such as gonorrhea or chlamydia), endometriosis and prior surgery of the fallopian tube. In addition, pregnancy achieved through fertility treatments such as in vitro fertilization (IVF) or having an IUD in place are other risk factors as well.

v. How is an ectopic pregnancy treated?

In some cases, an ectopic can be managed with medication called methotrexate. This is only an option in women who don't have a contraindication to its use, are not showing signs that the ectopic is leaking or rupturing, are hemodynamically stable and the ectopic tissue is not large. This option requires close surveillance by a medical professional and frequent blood monitoring. In other instances, surgery may be needed, and it is often performed emergently and for life saving indications. In these situations either the tube is opened and the ectopic tissue is removed, or the tube is removed in its entirety.

 Verbena does not provide medical advice, diagnosis, or treatment and is not a medical provider. Discuss pregnancy issues, questions or concerns with your personal doctor.

If you think you may have a medical emergency, call your doctor or 911 immediately.