During a normal, healthy pregnancy, the fertilized egg implants in the uterus. In an ectopic or tubal pregnancy, the fertilized egg does not reach its final destination and instead implants elsewhere. Most tubal pregnancies occur in a woman's fallopian tubes, although in rare cases they can occur in the ovary, abdomen or cervix. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies.
Risk Factors
The Mayo Clinic estimates that 20 out of every 1,000 pregnancies are tubal. Tubal pregnancies tend to occur when the fallopian tube is damaged, has scar tissue or is oddly shaped, causing the egg to get stuck during its journey to the uterus. Other risk factors include inflammation or infections of the fallopian tubes and/or uterus, often caused by gonorrhea or chlamydia. Women with endometriosis, a condition that causes uterine tissue to develop outside the uterus, are at higher risk for a tubal pregnancy. Ovulation stimulation medication as well as pregnancies that occur while on birth control pills or intrauterine devices can increase a woman's chances for tubal pregnancy. Pregnancy following a tubal ligation, while rare, is more likely to be ectopic. Women who smoke, are over the age of 35 or who have had a previous tubal pregnancy, are more likely to experience one again.
Symptom Progression
During an early tubal pregnancy, many women experience symptoms. Those who do, report that tubal symptoms are similar to those of a normal pregnancy. The first warning signs that the pregnancy is not in the right location often include light vaginal bleeding together with cramping on one side of the pelvis and lower abdominal pain. As the pregnancy progresses, symptoms can become more severe and require immediate medical attention. They include sharp pains in the pelvis, abdomen or even the shoulder and neck. Extreme dizziness/lightheadedness or even fainting along with the urge to defecate without results are also symptoms of a tubal pregnancy.
Complications
A tubal pregnancy that goes undetected can be life altering or even life threatening. Late treatment, according to the Mayo Clinic, can cause loss of an ovary or fallopian tube. If the tube ruptures as a result of the growing fertilized egg, life-threatening blood loss is possible.
Treatment
A doctor usually discovers an ectopic pregnancy by performing a pelvic exam to see if the uterus has grown in size, and ordering blood or urine tests to verify human chorionic gonadotropin (hCG) hormone levels. A small uterus and a low-hCG level can indicate tubal pregnancy, which is usually confirmed with an ultrasound or sonogram. To prevent life-threatening complications, the ectopic tissue must be removed. In an early pregnancy, the drug methotrexate is injected into the egg to stop its growth. The drug dissolves the egg which then gets reabsorbed by the body. When an ectopic pregnancy is discovered later, laparoscopic surgery is usually required. During this surgery a small incision is made near the naval, and the tissue is removed via a tube. Surgical instruments are inserted into the tube to remove the ectopic tissue and repair or remove the fallopian tube.
Prognosis
Successful pregnancy after an ectopic pregnancy may still be possible, although women with an ectopic pregnancy are more likely to have another one. In the case of a damaged or removed fallopian tube, many women are able to successfully conceive via the other tube. In vitro fertilization, where mature eggs are fertilized in a lab and implanted directly to the uterus, is a viable option for women who wish to get pregnant following a tubal pregnancy.
