Ectopic means "out of place." In an ectopic pregnancy, a fertilized egg has implanted outside the uterus.

The egg settles in the fallopian tubes in more than 95% of ectopic pregnancies. This is why ectopic

pregnancies are commonly called "tubal pregnancies." The egg can also implant in the ovary, abdomen, or

the cervix, so you may see these referred to as cervical or abdominal pregnancies.None of these areas has

as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will

eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life.

A classical ectopic pregnancy does not develop into a live birth.

Signs and Symptoms

Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early

pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent

urination.The first warning signs of an ectopic pregnancy are often pain or vaginal bleeding. You might feel

pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured

ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and

stabbing. It may concentrate on one side of the pelvis and come and go or vary in intensity.Any of the

following additional symptoms can also suggest an ectopic pregnancyvaginal spotting dizziness or fainting

(caused by blood loss) low blood pressure (also caused by blood loss) lower back pain

What Causes an Ectopic Pregnancy?An ectopic pregnancy results from a fertilized egg's inability to
work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the
tube might have partially or entirely blocked it. Pelvic inflammatory disease (PID), which can be caused by
gonorrhea or chlamydia, is a common cause of blockage of the fallopian tube.Endometriosis (when cells
from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous
abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths
can alter the shape of the tube and disrupt the egg's progress.
DiagnosisIf you arrive in the emergency department complaining of abdominal pain, you'll likely be given
a urine pregnancy test. Although these tests aren't sophisticated, they are fast — and speed can be crucial
in treating ectopic pregnancy.

If you already know you're pregnant, or if the urine test comes back positive, you'll probably be given a

quantitative hCG test. This blood test measures levels of the hormone human chorionic gonadotropin

(hCG), which is produced by the placenta and appears in the blood and urine as early as 8 to 10 days

after conception. Its levels double every 2 days for the first several weeks of pregnancy, so if hCG levels

are lower than expected for your stage of pregnancy, one possible explanation might be an ectopic

pregnancy.You'll probably also get an ultrasound examination, which can show whether the uterus

contains a developing fetus or if masses are present elsewhere in the abdominal area. But the ultrasound

might not be able to detect every ectopic pregnancy. The doctor may also give you a pelvic exam to locate

the areas causing pain, to check for an enlarged, pregnant uterus, or to find any masses.

Even with the best equipment, it's hard to see a pregnancy less than 5 weeks after the last menstrual

period. If your doctor can't diagnose ectopic pregnancy but can't rule it out, he or she may ask you to

return every 2 or 3 days to measure your hCG levels. If these levels don't rise as quickly as they should,

the doctor will continue to monitor you carefully until an ultrasound can show where the pregnancy is.

Options for Treatment

Treatment of an ectopic pregnancy varies, depending on how medically stable the woman is and the size

and location of the pregnancy.An early ectopic pregnancy can sometimes be treated with an injection of

methotrexate, which stops the growth of the embryo.If the pregnancy is further along, you'll likely need

surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring a large

incision across the pelvic area. This might still be necessary in cases of emergency or extensive internal

injury.However, the pregnancy may sometimes be removed using laparoscopy, a less invasive surgical

procedure. The surgeon makes small incisions in the lower abdomen and then inserts a tiny video camera

and instruments through these incisions. The image from the camera is shown on a screen in the

operating room, allowing the surgeon to see what’s going on inside of your body without making large

incisions. The ectopic pregnancy is then surgically removed and any damaged organs are repaired or

removed.

Whatever your treatment, the doctor will want to see you regularly afterward to make sure your hCG

levels return to zero. This may take several weeks. An elevated hCG could mean that some ectopic tissue

was missed. This tissue may have to be removed using methotrexate or additional surgery.

What About Future Pregnancies?Some women who have had ectopic pregnancies will have difficulty
becoming pregnant again.This difficulty is more common in women who also had fertility problems before
the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as
the extent of the damage that was done.The likelihood of a repeat ectopic pregnancy increases with each
subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15%
chance of having another.
Who's at Risk for an Ectopic Pregnancy?While any woman can have an ectopic pregnancy, the risk is
highest for women who are over 35 and have had:

• PID

• a previous ectopic pregnancy

• surgery on a fallopian tube

• infertility problems or medication to stimulate ovulation

Some birth control methods can also affect your risk of ectopic pregnancy. If you get pregnant while using

progesterone-only oral contraceptives, progesterone intrauterine devices (IUDs), or the morning-after pill,

you might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also

increases the risk of an ectopic pregnancy.When to Call Your DoctorIf you believe you're at risk for an

ectopic pregnancy, meet with your doctor to discuss your options before you become pregnant. You can

help protect yourself against a future ectopic pregnancy by not smoking and by always using condoms

when you're having sex but not trying to get pregnant. Condoms can protect against sexually transmitted

infections (STDs) that can cause PID.If you are pregnant and have any concerns about the pregnancy

being ectopic, talk to your doctor — it's important to make sure it's detected early. You and your doctor

might want to plan on checking your hormone levels or scheduling an early ultrasound to ensure that your

pregnancy is developing normally.Call your doctor immediately if you're pregnant and experiencing any

pain, bleeding, or other symptoms of ectopic pregnancy. When it comes to detecting an ectopic

pregnancy, the sooner it is found, the better.

The following may reduce your risk: Ectopic pregnancies cannot continue to birth (term). The developing cells must be
removed to save the mother's life.

You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to
shock, an emergency condition. Treatment for shock may include:

• Blood transfusion
• Fluids given through a vein
• Keeping warm
• Oxygen
• Raising the legs

If there is a rupture, surgery (laparotomy) is done to stop blood loss. This surgery is also done to:

• Confirm an ectopic pregnancy

• Remove the abnormal pregnancy
• Repair any tissue damage

In some cases, the doctor may have to remove the fallopian tube.

A minilaparotomy and laparoscopy are the most common surgical treatments for an ectopic pregnancy that has not
ruptured. If the doctor does not think a rupture will occur, you may be given a medicine called methotrexate and
monitored. You may have blood tests and liver function tests.

Outlook (Prognosis)
Most women who have had one ectopic pregnancy are later able to have a normal pregnancy. A repeated ectopic
pregnancy may occur in 10 - 20% of women. Some women do not become pregnant again.

The rate of death due to an ectopic pregnancy in the United States has dropped in the last 30 years to less than 0.1%.

Possible Complications

The most common complication is rupture with internal bleeding that leads to shock. Death from rupture is rare. Infertility
occurs in 10 - 15% of women who have had an ectopic pregnancy.

When to Contact a Medical Professional

If you have symptoms of ectopic pregnancy (especially lower abdominal pain or abnormal vaginal bleeding), call your
health care provider. You can have an ectopic pregnancy if you are able to get pregnant (fertile) and are sexually active,
even if you use birth control.

Prevention

Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. However, a tubal
pregnancy (the most common type of ectopic pregnancy) may be prevented in some cases by avoiding conditions that
might scar the fallopian tubes.

• Avoiding risk factors for pelvic inflammatory disease (PID) such as having many sexual partners, having sex
without a condom, and getting sexually transmitted diseases (STDs)
• Early diagnosis and treatment of STDs
• Early diagnosis and treatment of salpingitis and PID

Alternative Names

Tubal pregnancy; Cervical pregnancy; Abdominal pregnancy