An ectopic pregnancy is a pregnancy that develops in the wrong location. Rather than growing inside the uterus as a normal pregnancy, an ectopic pregnancy lodges in a location outside the uterus such as the fallopian tube, ovary or abdominal cavity.
In a normal pregnancy, the sperm and egg meet inside the fallopian tube and the fertilized ovum then progress to the uterus where it implants inside uterine cavity. If the fertilized egg fails to migrate into the uterus, it may implant in an improper location where it develops and ultimately, injures the organ to which it is attached. The commonest abnormal location is inside the fallopian tube and is referred to as a tubal pregnancy. With growth of the pregnancy, the tube may rupture causing pain and internal bleeding. As a result, if an ectopic pregnancy is allowed to progress it can cause a dangerous health situation.
The symptoms of ectopic pregnancy include vaginal bleeding, abdominal pain, weakness or pain in your shoulders, neck or rectum. A history of infertility or prior sterilization increases the suspicion for an ectopic pregnancy. The commonest risk factor for an ectopic pregnancy is a prior ectopic pregnancy. Unfortunately, there are other conditions of pregnancy that may cause vaginal bleeding or pain, so history alone is not sufficient to determine if the pregnancy is ectopic. Usually, lab work and sonograms are required to diagnose an ectopic pregnancy.
Initially, a fertilized egg is no bigger than a particle of dust and not visible by ultrasound. However, as soon as implantation occurs, the pregnancy produces human choriogonadatropin (HCG). As the pregnancy grows, the HCG level in the blood stream rises. In early pregnancy, the HCG level may double every two to three days. Usually by the time the pregnancy is visible by ultrasound, the HCG level may be greater than 3000. This means HCG levels and ultrasound can be used to track the growth of the pregnancy and to confirm that the pregnancy is growing inside the uterus. Visualizing the pregnancy outside the uterus or failing to visualize the pregnancy when HCG level suggest the pregnancy should be visualized confirms the diagnosis of ectopic pregnancy.
Regrettably, an ectopic pregnancy cannot be transplanted to inside the uterus. The goal of the treatment of ectopic pregnancy is to resolve the pregnancy and either limit or repair injury caused by abnormal placement of the pregnancy.
If an ectopic pregnancy is detected early before internal bleeding or injury to internal organs, it can be treated medically. Methotrexate is a medicine that is used to resolve the pregnancy without surgery. Your doctor will need to discuss with you where you are a candidate for non-surgical treatment.
In cases where there is internal bleeding or injury to internal organs, surgery is required. Laparoscopy is the preferred surgical method to remove the ectopic pregnancy. When possible, the injured fallopian tube is not removed. However, if the injured tube does not appear to be functional, the surgeon may remove the injured tube to avoid causing another ectopic pregnancy in the future. The surgery to remove the tube is called salpinjectomy. If the unaffected tube is in good condition, removal of the injured tube will not only resolve the ectopic pregnancy but decrease the chance of another ectopic pregnancy in the future and, ironically, promote fertility as well.
Ectopic pregnancy has all the disappointment of a miscarriage and the added anxiety of a dangerous health situation and surgery. The physicians and staff at OB GYN Associates will be able to help you through this difficult diagnosis and help you with the safest resolution of a fearful medical issue.