An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus.

• Risk factors for ectopic pregnancy include previous ectopic pregnancies and conditions (surgery, infection) that disrupt the normal anatomy of the Fallopian tubes.
• The major health risk of an ectopic pregnancy is internal bleeding.
• Diagnosis of ectopic pregnancy is usually established by blood hormone tests and pelvic ultrasound.
• Treatment options for ectopic pregnancy include both surgery and medication.

What is an ectopic pregnancy?

An ectopic pregnancy (EP) is a condition in which a fertilized egg settles and grows in any location other than the inner lining of the uterus. The vast majority of ectopic pregnancies are so-called tubal pregnancies and occur in the Fallopian tube. However, they can occur in other locations, such as the ovary, cervix, and abdominal cavity. An ectopic pregnancy occurs in about one in 50 pregnancies. A molar pregnancy differs from an ectopic pregnancy in that it is usually a mass of tissue derived from an egg with incomplete genetic information that grows in the uterus in a grape-like mass that can cause symptoms to those of pregnancy.

The major health risk of ectopic pregnancy is rupture leading to internal bleeding. Before the 19th century, the mortality rate (death rate) from ectopic pregnancies exceeded 50%. By the end of the 19th century, the mortality rate dropped to five percent because of surgical intervention. Statistics suggest with current advances in early detection, the mortality rate has improved to less than five in 10,000. The survival rate from ectopic pregnancies is improving even though the incidence of ectopic pregnancies is also increasing. The major reason for a poor outcome is failure to seek early medical attention. Ectopic pregnancy remains the leading cause of pregnancy-related death in the first trimester of pregnancy.

In rare cases, an ectopic pregnancy may occur at the same time as an intrauterine pregnancy. This is referred to as heterotopic pregnancy. The incidence of heterotopic pregnancy has risen in recent years due to the increasing use of IVF (in vitro fertilization) and other assisted reproductive technologies (ARTs). For additional diagrams and photos, please see the last reference listed below.

You may not notice anything at first. However, some women with an ectopic pregnancy have the usual early signs or symptoms of pregnancy — a missed period, Breast Tenderness and nausea.

If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal.

Signs and symptoms increase as the fertilized egg grows in the improper place.

Early warning of ectopic pregnancy

Often, the first warning sign of an ectopic pregnancy is pelvic pain. Light Vaginal bleeding may also occur.

If blood leaks from the fallopian tube, you may feel increasing abdominal pain, an urge to have a bowel movement or pelvic discomfort. If heavy bleeding (hemorrhaging) occurs, you may feel shoulder pain as blood fills your pelvis and abdomen. Your specific symptoms depend on where the blood collects and which nerves are irritated.

Emergency symptoms

If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. Symptoms of this life-threatening event include extreme lightheadedness, fainting, severe Abdominal pain and shock.

When to see a doctor

Seek emergency medical help if you have any signs or symptoms of an ectopic pregnancy, including:

• Severe abdominal or Pelvic pain during pregnancy
• Abnormal vaginal bleeding
• Extreme lightheadedness or fainting
• Other concerning symptoms, especially if you have risk factors for an ectopic pregnancy

A tubal pregnancy — the most common type of ectopic pregnancy — happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role.

A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. Depending on your symptoms and when the ectopic pregnancy is discovered, this may be done using a medication, laparoscopic surgery or abdominal surgery.

Medication

An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection. It's very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment.

After the injection, your doctor will order another HCG test to determine how well the treatment is working, and if you need more medication.

Laparoscopic procedures

Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. In these procedure, a small incision is made in the abdomen, near or in the navel. Next, your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the tubal area.

In a salpingostomy, the ectopic pregnancy is removed and the tube left to heal on its own. In a salpingectomy, the ectopic pregnancy and the tube are both removed.

Which procedure you have depends on the amount of bleeding and damage and whether the tube has ruptured. Also a factor is whether your other fallopian tube is normal or shows signs of prior damage.

Emergency surgery

If the ectopic pregnancy is causing heavy bleeding, you might need emergency surgery. This can be done laparoscopically or through an abdominal incision (laparotomy). In some cases, the fallopian tube can be saved. Typically, however, a ruptured tube must be removed.

Some things that make you more likely to have an ectopic pregnancy are:

• Previous ectopic pregnancy. If you've had this type of pregnancy before, you're more likely to have another.
• Inflammation or infection. Sexually transmitted infections, such as gonorrhea or chlamydia, can cause inflammation in the tubes and other nearby organs, and increase your risk of an ectopic pregnancy.
• Fertility treatments. Some research suggests that women who have in vitro fertilization (IVF) or similar treatments are more likely to have an ectopic pregnancy. Infertility itself may also raise your risk.
• Tubal surgery. Surgery to correct a closed or damaged fallopian tube can increase the risk of an ectopic pregnancy.
• Choice of birth control. The chance of getting pregnant while using an intrauterine device (IUD) is rare. However, if you do get pregnant with an IUD in place, it's more likely to be ectopic. Tubal ligation, a permanent method of birth control commonly known as "having your tubes tied," also raises your risk, if you become pregnant after this procedure.
• Smoking. Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. The more you smoke, the greater the risk.

The good news is that, for most women, an ectopic pregnancy can be treated and cured.

• If you're experiencing symptoms of an ectopic pregnancy, you'll want to get to the doctor ASAP. The sooner you're diagnosed and treated, the more likely it is that your pregnancy will be saved.
• The first thing your doctor will do is take a sample of your blood or urine to test for hCG levels. If those are high enough, this means that there is still a viable fetus growing inside of you-which means there's still hope!
• If the hCG levels aren't high enough yet, though, this may mean that it's too early to tell if there's any chance of saving your pregnancy. If that's the case, doctors may recommend waiting until they can test again in a few days.
• Once they've determined whether or not there's a viable fetus inside of you, they'll make recommendations about treatment options based on their findings.

Some treatments include:

• Methotrexate (MTX): This drug can be used to treat ectopic pregnancy and is typically given in combination with a steroid and folate supplementation.
• Methotrexate + mifepristone: This combination of drugs is used to treat certain types of ectopic pregnancies as well as early miscarriages. The mifepristone blocks the effects of progesterone, which is needed for the embryo to implant in the uterus.
• Painkillers (like ibuprofen or acetaminophen)
• Antibiotics (to prevent infection)
• Progesterone (to encourage embryo attachment to the uterus)
• If you have an ectopic pregnancy, your doctor may recommend bed rest, which means you should avoid any activity that could make your symptoms worse. It's also important to avoid strenuous activities and heavy lifting.
• While your doctor will probably give you some medication to help with the pain of your ectopic pregnancy, it's important to follow her directions closely when taking any medication.

Symptoms
Pain in the abdomen,Vaginal bleeding or spotting,Darker than normal or no vaginal discharge,Pain in the shoulder or upper back on one side of your body,Abdominal bloating, which may start out mild and then increase in severity over time
Conditions
Tubal pregnancy
Drugs
Methotrexate,Methotrexate with Misoprostol,Misoprostol (brand name Cytotec),Dinoprostone (brand name Prostin E2),Laminaria (brand name Laminarix),Prostaglandins