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In a small number of pregnancies, the fertilized egg attaches to an area outside of the uterus, rather than in the uterus. This is called an ectopic pregnancy or extrauterine pregnancy.
Nearly all ectopic pregnancies develop in a fallopian tube. These are often called tubal pregnancies. If left untreated, a tubal ectopic pregnancy can cause fallopian tube damage and cause heavy bleeding that could be deadly. So unless the pregnancy is miscarrying on its own, medicine or surgery is used to treat the ectopic pregnancy.
Ectopic pregnancy can also occur in an ovary, the cervix, or the abdomen. This is rare.
An ectopic pregnancy is often caused by damaged fallopian tubes. A fertilized egg may have trouble passing through a damaged tube, causing the egg to implant and grow in the tube. Fallopian tube damage may be caused by things like pelvic inflammatory disease or smoking. Some ectopic pregnancies occur without any known cause.
In the first few weeks, an ectopic pregnancy may cause the same symptoms as a normal pregnancy, such as a missed menstrual period, fatigue, nausea, and sore breasts.
The key signs of an ectopic pregnancy are:
A urine test can show if you are pregnant. If you have symptoms of a possible ectopic pregnancy, your doctor will likely do a pelvic examination, a blood test, and an ultrasound.
In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. Treatment may be medicine or surgery. Rarely, the doctor may recommend what's called expectant management. The decision about which treatment to use depends on how early the pregnancy is found and your overall condition.
You may have many different emotions after an ectopic pregnancy. If you need help coping with any feelings, consider meeting with a support group. You also may want to read about others' experiences or talk with a friend, family member, or counsellor. If you're sad and it's not getting any easier, tell your doctor.
Fallopian tube damage is a common cause of ectopic pregnancy. A fertilized egg can get caught in the damaged area of a tube and start to grow there. Some ectopic pregnancies occur without any known cause.
Common causes of fallopian tube damage that may lead to an ectopic pregnancy include:
Some medical treatments can increase your risk. These include:
You may be able to prevent an ectopic pregnancy by reducing things that may put you at risk for having one.
Smoking or vaping tobacco increases your risk for ectopic pregnancy. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
Try to use safer sex practices, such as using a condom every time you have sex. Use an external condom, which goes on the penis. Or use an internal condom, which goes into the vagina or anus. This will help protect you from sexually transmitted infections (STIs) that can lead to pelvic inflammatory disease (PID). PID is a common cause of scar tissue in the fallopian tubes, which can cause ectopic pregnancy.
If you have one or more risk factors for ectopic pregnancy, you and your doctor can closely monitor your first weeks of a pregnancy.
The early signs of an ectopic pregnancy are:
As an ectopic pregnancy progresses or ruptures, other symptoms develop. They include:
Normally, at the start of a pregnancy, the fertilized egg travels from the fallopian tube to the uterus, where it implants and grows. But in a small number of pregnancies, the fertilized egg attaches to an area outside of the uterus. This results in an ectopic pregnancy (also known as a tubal pregnancy or an extrauterine pregnancy).
An ectopic pregnancy cannot support the life of a fetus for very long. But an ectopic pregnancy can grow large enough to rupture the area and cause heavy bleeding, which is dangerous. If you have signs or symptoms of an ectopic pregnancy, you need immediate medical care.
An ectopic pregnancy can develop in different locations. In most cases, the fertilized egg has implanted in a fallopian tube.
In rare cases:
It's common to worry about your fertility after an ectopic pregnancy. Having an ectopic pregnancy doesn't mean that you can't have a normal pregnancy in the future. But it does mean that:
If you get pregnant again, be sure your doctor knows that you had an ectopic pregnancy before. Regular testing in the first weeks of pregnancy can find a problem early or let you know that the pregnancy is okay.
If you are pregnant, be alert to the symptoms that may mean you have an ectopic pregnancy, especially if you are at risk. If you have symptoms of or are being treated for an ectopic pregnancy, avoid strenuous activity until your symptoms have been checked by a doctor.
Call 911 or other emergency services immediately if:
Call your doctor or nurse advice line now or seek immediate medical care if:
A urine test can show if you are pregnant. If you have symptoms of a possible ectopic pregnancy, you will have:
During the week after treatment for an ectopic pregnancy, your hCG blood levels are tested several times. In some cases, hCG testing continues for weeks to months until hCG levels drop to a low level.
In some cases, you may have expectant management. This means your doctor monitors your pregnancy hormone (hCG) levels to check if they are dropping on their own. But in most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. The decision about which treatment to use depends on how early the pregnancy is found and your overall condition.
Medicine can be used if the pregnancy is found early, before the pregnancy has grown too big. In most cases, one or more shots of a medicine called methotrexate are given. You will need follow-up blood tests for several weeks to make sure the treatment worked.
Surgery may be used if the ectopic pregnancy is found later or is causing internal bleeding or high hCG levels. The surgery may be done through one or more small cuts (incisions) in your belly. If you need emergency surgery, you may have a larger incision.
A medicine called methotrexate is usually the first treatment choice for an early ectopic pregnancy. Whether medicine can be used depends on how early the pregnancy is found and your overall condition. It is not an option if the pregnancy has grown too big or the fallopian tube has ruptured.
Methotrexate is usually given as one or more shots injected into a muscle. After the shot, you'll need follow-up blood tests for several weeks. These tests are to make sure that the medicine worked.
Methotrexate may cause belly cramps and pain that last a few days. And it can also cause side effects, such as nausea, indigestion, and diarrhea.
For an ectopic pregnancy that is more developed, surgery is a safer and more dependable treatment. Sometimes methotrexate is used after surgery. It's to make sure that all ectopic cell growth has stopped.
Surgery is the fastest way to treat an ectopic pregnancy. The two types of surgery are:
The doctor removes the ectopic growth through a small cut in the fallopian tube. This is called linear salpingostomy. The cut is left to close by itself. Or it may be stitched closed.
The doctor removes a part of the fallopian tube. The remaining healthy fallopian tube may be reconnected. This surgery is needed when the fallopian tube is so stretched that it may rupture. It's also used when the tube has already ruptured or is very damaged.
These surgeries can be done in two ways. The first is through a small incision using laparoscopy. The second is called laparotomy. It's done through a larger incision in the belly. Laparoscopy takes less time than laparotomy. And the hospital stay is usually shorter.
If the fallopian tube that isn't part of the ectopic pregnancy is healthy, then both surgeries have about the same effect on future fertility. But if that other fallopian tube isn't healthy, then your doctor may try to do a salpingostomy.
Adaptation Date: 6/15/2023
Adapted By: Alberta Health Services
Adaptation Reviewed By: Alberta Health Services
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