Ectopic Pregnancy

What is Ectopic Pregnancy 

Ectopic pregnancy happens when a fertilized egg grows outside the womb (uterus). The fertilized egg cannot stay alive outside of the womb. This problem often happens in a fallopian tube. It is often caused by damage to the tube.

An ectopic pregnancy refers to a pregnancy located anywhere outside of the endometrial cavity.

5 Interesting Facts of Ectopic Pregnancy

1. Pregnancy occurring outside the uterine cavity, most commonly in the fallopian tube
2. Similar to threatened miscarriage in early pregnancy, can present with abdominal or pelvic pain, vaginal bleeding, and history of delayed or absent menses
   • Consider in any woman who has abdominal pain or vaginal bleeding and a positive pregnancy test result 
   • Patients with hemodynamic instability or an acute abdomen are evaluated and treated urgently
3. Patient may have palpable adnexal mass or suggestive history (eg, ectopic pregnancy, tubal surgery, assisted reproductive techniques, pelvic inflammatory disease, endometriosis, intrauterine device use)
4. Diagnostic evaluation includes transvaginal ultrasonographic evaluation and hormonal confirmation of pregnancy (eg, serum hCG level) 
   • Serial evaluation with transvaginal ultrasonography, serum hCG levels, or both, is often required to confirm diagnosis
5. Ectopic pregnancy in an unstable patient is a medical emergency and requires prompt surgical intervention

How common is ectopic pregnancy

Ectopic pregnancies occur with a frequency of approximately 14 in 1000 pregnancies.

An ectopic pregnancy most commonly occurs in the fallopian tube (95% to 97% of cases), typically in the isthmic or ampullary portion of the tube.

Other sites include the interstitial portion of the fallopian tube (interstitial pregnancy) (2% to 5%), the ovary (1%), the cervix (<0.1%), and the abdominal cavity (<0.1%).

Who is at increased risk for an ectopic pregnancy?

Women with a history of prior ectopic pregnancy, pelvic inflammatory disease, fallopian tube surgery, in vitro fertilization, or use of an intrauterine contraceptive device are at increased risk for an ectopic pregnancy.

What are the symptoms

What is the classic clinical presentation of an ectopic pregnancy?

Approximately 45% of patients with ectopic pregnancies present with the clinical triad of vaginal bleeding, pelvic pain, and a palpable adnexal mass.

How is an ectopic pregnancy diagnosed?

Possible Ultrasound findings associated with an ectopic pregnancy

• • Embryo located outside of the uterus (5% to 10% of cases): 100% diagnostic of an ectopic pregnancy.
• • Complex or solid adnexal mass: the most common finding.

• • Moderate to large amount of pelvic free fluid, especially if particulate.
• • Empty uterus in conjunction with serum β-hCG level that is above the level at which a gestational sac should be seen.

How is this condition treated?

If this problem is found early, you may be treated with medicine that stops the egg from growing. If your tube tears or bursts open (ruptures), you will bleed inside. Often, there is very bad pain in the lower belly. This is an emergency. You will need surgery. Get help right away.

Follow these instructions at home:

After being treated with medicine or surgery:

• Rest and limit your activity for as long as told by your doctor.
• Until your doctor says that it is safe:
  • Do not lift anything that is heavier than 10 lb (4.5 kg) or the limit that your doctor tells you.
  • Avoid exercise and any movement that takes a lot of effort.
• To prevent problems when pooping (constipation):
  • Eat a healthy diet. This includes:
    • Fruits.
    • Vegetables.
    • Whole grains.
  • Drink 6–8 glasses of water a day.

Contact a doctor if:

Get help right away if:

• You have sudden and very bad pain in your belly.
• You have very bad pain in your shoulders or neck.
• You have pain that gets worse and is not helped by medicine.
• You have:
  • A fever or chills.
  • Vaginal bleeding.
  • Redness or swelling at the site of a surgical cut (incision).
• You feel sick to your stomach (nauseous) or you throw up (vomit).
• You feel dizzy or weak.
• You feel light-headed or you pass out (faint).

Summary

• An ectopic pregnancy happens when a fertilized egg grows outside the womb (uterus).
• If this problem is found early, you may be treated with medicine that stops the egg from growing.
• If your tube tears or bursts open (ruptures), you will need surgery. This is an emergency. Get help right away.