Ectopic Pregnancy (cont.)
What is the health risk of an ectopic pregnancy?
Some women spontaneously absorb their ectopic pregnancy
with no apparent ill effects, and can be observed without treatment. However,
the true incidence of spontaneous resolution of ectopic pregnancies is unknown. It is not possible to
predict which women will spontaneously resolve their ectopic pregnancies.
The most feared complication of an ectopic pregnancy is
internal bleeding, causing pelvic and abdominal pain, shock, and even death. Therefore, bleeding in
an ectopic pregnancy may require immediate surgical attention. Bleeding results
from the rupture of the Fallopian tube or from blood leaking from the end of the
tube as the growing placenta erodes into the veins and arteries located inside
the tubal wall. Blood coming from the tube can be very irritating to other
tissues and organs in the pelvis and abdomen, and result in significant pain.
The pelvic blood can lead to scar tissue formation and problems with becoming
pregnant in the future. The scar tissue can also increase the risk of future
ectopic pregnancies.
What treatment options are available for ectopic pregnancy?
Treatment options for ectopic pregnancy include observation, laparoscopy,
laparotomy, and
medication. Selection of these options is individualized. Some
ectopic pregnancies will resolve on their own without the need for any
intervention, while others will need urgent surgery due to life-threatening
bleeding. However, because of the risk of rupture and potential dire
consequences, most women with a diagnosed ectopic pregnancy are treated with
medications or surgery.
For those who require intervention, the most common
treatment is surgery. Two surgical options are available; laparotomy and
laparoscopy. Laparotomy is an open procedure whereby a transverse (bikini line)
incision is made across the lower abdomen. Laparoscopy involves inserting
viewing instruments into the pelvis through tiny incisions in the skin. For many surgeons and patients,
laparoscopy is preferred over laparotomy because of the tiny incisions used and
the speedy recovery afterwards. Under optimal conditions, a small incision can
be made in the Fallopian tube and the ectopic pregnancy removed, leaving the
Fallopian tube intact. However, certain conditions make laparoscopy less
effective or unavailable as an alternative. These include massive pelvic scar
tissue and excessive blood in the abdomen or pelvis. In some instances, the
location or extent of damage may require removal of a portion of the Fallopian
tube, the entire tube, the ovary, and even the uterus.
Medical therapy can also be successful in treating
certain groups of women who have an ectopic pregnancy. This treatment method
involves the use of an anti-cancer drug called methotrexate. This drug acts by killing the growing
cells of the placenta, thereby inducing miscarriage of the ectopic pregnancy.
Some patients may not respond to methotrexate, and will require surgical
treatment. Methotrexate is gaining popularity because of its high success rate
and low rate of side effects. There are certain factors, including the size of
the mass associated with the ectopic pregnancy and the blood beta HCG
concentrations that help doctors decide which women are candidates for medical
rather than surgical treatment.
Although there have been a few reported cases of women giving birth by
cesarean section to live infants that were located outside the uterus, this is
extremely rare. The chance of carrying an ectopic pregnancy to full term is so
remote, and the risk to the woman so great, that it can never be recommended. It
would be ideal if an ectopic pregnancy in the Fallopian tube could be saved by
surgery to relocate it into the uterus. This concept has yet to become a
accepted as a successful procedure.
Overall, there have been great advances in the early diagnosis and treatment
of ectopic pregnancy, and the mortality from this condition has decreased
dramatically.
Ectopic Pregnancy At A Glance
- 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.
References: MMWR Morb Mortal Wkly Rep 1995 Jan 27;44(3):46-8. Ectopic pregnancy--United States, 1990-1992.; Yao, M, Tulandi, T. Current status of surgical and non-surgical treatment of ectopic pregnancy. Fertil Steril 1997; 67:421.
Last Editorial Review: 3/20/2007
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