Ectopic Pregnancy

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

• What is an ectopic pregnancy?
• What are the risk factors for ectopic pregnancy?
• What are symptoms of an ectopic pregnancy?
• How is ectopic pregnancy diagnosed?
• What is the health risk of an ectopic pregnancy?
• What treatment options are available for ectopic pregnancy?
• Ectopic Pregnancy At A Glance
• Patient Discussions: Ectopic Pregnancy - Symptoms Experienced

Featured ectopic pregnancy patient discussions on symptoms experienced "I was 21 when I had my first ectopic pregnancy, which led to me having my right tube removed. The pain started in my tube and went up to my shoulder. The reason I am writing this is because I was told the chances of me having children were slim. Sadly, I did have six miscarriages. But in 2004, I had my wonderful little boy. Last week, the pain started again, and I was taken into the hospital. I was told I was having another ectopic pregnancy, which led to my left tube being removed. The point I am trying to make is it can have a happy ending, so don’t give up." "Last year in November I had my operation for an ectopic pregnancy. It was the most excruciating pain that I ever encountered. The pain was only on the right side. The doctors said I can become pregnant again, but there is a 95% chance that it could be an ectopic pregnancy again on the left side. I doubt I’ll ever be pregnant thinking of that pain." "I had my ectopic pregnancy when I was 22 years old, and I will never forget how bad the pain was and how unwell I became. My symptoms started with spotting, and then I began having shoulder pain, which was very uncomfortable and worsened during the night. This was followed by extreme abdominal pain. It started like a stomach ache and then got worse. I also had diarrhea and constantly felt as if I needed to poo/pee. I was first diagnosed and sent home from the hospital with a stomach bug. (Good job, guys!) I got a second opinion, and was then diagnosed with an ectopic pregnancy. I had my left tube removed completely. I became pregnant six months later and now have a gorgeous daughter. I am now 25 and still worry about this happening again in the future." Read All Comments on Ectopic Pregnancy » Top Searched Ectopic Pregnancy Terms: symptoms, misdiagnosed, clomid, hcg levels, ivf, shoulder pain, pregnancy test, scoliosis, pregnancy, miscarriage, endometriosis, ovarian cysts, methotrexate Patient Discussions are not a substitute for professional medical advice, or treatment. See the disclaimer at the bottom of the comments page.

What is an ectopic pregnancy?

An ectopic pregnancy 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 occur in the Fallopian tube (98%), 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.

The major health risk of ectopic pregnancy is rupture leading to internal bleeding. Before the 19th century, the mortality rate (the 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. 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.

What are the risk factors for ectopic pregnancy?

There are multiple factors that increase a women's likelihood of having an ectopic pregnancy, but it is important to note that ectopic pregnancies can occur in women without any of these risk factors.

The greatest risk factor for an ectopic pregnancy is a prior history of an ectopic pregnancy. The recurrence rate is 15% after the first ectopic pregnancy, 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 sterilization 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, infection, congenital abnormalities, or tumors of the Fallopian tubes can increase a woman's risk of having an ectopic pregnancy.

Infection in the pelvis is another risk factor for ectopic pregnancy. Pelvic infections are usually caused by sexually-transmitted organisms, such as chlamydia or gonorrhea. However, non-sexually transmitted bacteria can also cause pelvic infection and increase the risk of an ectopic pregnancy. Infection causes an ectopic pregnancy by damaging or obstructing the Fallopian tubes. Normally, the inner lining of the Fallopian tubes is coated with small hair-like projections called cilia. These cilia are important to transport the egg smoothly from the ovary through the Fallopian tube and into the uterus. If these cilia are damaged by infection, egg transport becomes disrupted. The fertilized egg can settle in the Fallopian tube without reaching the uterus, thus becoming an ectopic pregnancy. Likewise, infection-related scarring and partial blockage of the Fallopian tubes can also prevent the egg from reaching the uterus.

Like pelvic infections, conditions such as endometriosis, fibroid tumors, or pelvic scar tissue (pelvic adhesions), can narrow the Fallopian tubes and disrupt egg transportation, thereby increasing the chances of an ectopic pregnancy.

Approximately 50% of pregnancies in women using intrauterine devices (IUDs) will be located outside of the uterus. However, the total number of women becoming pregnant while using IUDs is extremely low. Therefore, the overall number of ectopic pregnancies related to IUDs is very low.

Cigarette smoking around the time of conception has also been associated with an increased risk of ectopic pregnancy. This risk was observed to be dose-dependent, which means that the risk is dependent upon the individual woman's habits and increases with the number of cigarettes smoked.

Ectopic Pregnancy - Symptoms Experienced

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