1. Cause and Effect
An ectopic pregnancy occurs when an egg is fertilized somewhere other than the lining of the uterus. Approximately 95 percent of ectopic pregnancies occur in the fallopian tubes. Ectopic pregnancies have also been found in the abdomen, ovaries and cervix. Women with a history of pelvic inflammatory disease are six to ten times more likely to have an ectopic pregnancy. The use of progesterone contraceptives, such as a progesterone-based intrauterine device, increases the chances of having an ectopic pregnancy. Death can result if an ectopic pregnancy goes untreated, but the number of ectopic pregnancy-related deaths has dropped drastically since 1970.
2. No Treatment Needed
Some ectopic pregnancies resolve themselves without treatment. If pregnancy hormone levels, also called human chorionic gonadotropin or hCG levels, are dropping, the pregnancy is likely terminating on its own. In this scenario, your doctor will frequently draw your blood to check your hormone levels to make sure they continue to drop. This is called expectant management.
3. Managed with Medication
When ectopic pregnancies are diagnosed early, medication might be all that's needed. Methotrexate is typically given by injection at two different injection sites to increase the absorption of the medication. Methotrexate can also be given by mouth, but it's not as effective as an injection. The medication works by stopping the growth of rapidly dividing cells. While taking methrotrexate, pregnancy hormone levels are checked several times to make sure they're dropping, usually for about a month. It's not unusual for hormone levels to spike slightly after beginning treatment and then begin to drop. If hormone levels don't drop, your doctor might recommend another dose of methrotrexate or surgery.
4. From Small Incisions to Emergency Surgery
Emergency surgery is needed if the ectopic pregnancy ruptures, which can cause severe internal bleeding. Your physician will also recommend surgery if the ectopic pregnancy is causing bleeding, high hormone levels or severe pregnancy symptoms, such as fatigue and nausea. Ectopic pregnancy surgeries are laparoscopic, meaning the surgeon uses a small instrument to view the surgical site, and only a small incision is needed. If possible, only a small slit is made in the affected fallopian tube rather than removing a section of it. Occasionally, a dose of methrotrexate is needed following surgery.
5. Reducing the Risk
Most factors that are believed to contribute to ectopic pregnancies can't be controlled, such as age and race. Women younger than 30 who have tubal ligation are twice as likely to have an ectopic pregnancy than those older than 30 with tubal ligation. Women with tubal ligations using bipolar tubal coagulation, meaning the tube is sealed with electrical current, are more likely to have an ectopic pregnancy than those who have their fallopian tubes cut. Progesterone contraceptives should be avoided if you're at an increased risk of having an ectopic pregnancy, particularly if you've had one in the past.
