Pregnancy
FAQ155, February 2018



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Ectopic Pregnancy

What is ectopic pregnancy?

An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus. Almost all ectopic pregnancies—more than 90%—occur in a fallopian tube. As the pregnancy grows, it can cause the tube to burst (rupture). A rupture can cause major internal bleeding. This can be a life-threatening emergency that needs immediate surgery.

What are the risk factors for ectopic pregnancy?

The risk factors for ectopic pregnancy include the following:

  • Previous ectopic pregnancy
  • Prior fallopian tube surgery
  • Previous pelvic or abdominal surgery
  • Certain sexually transmitted infections (STIs)
  • Pelvic inflammatory disease
  • Endometriosis

Other factors that may increase a woman’s risk of ectopic pregnancy include

  • cigarette smoking
  • age older than 35 years
  • history of infertility
  • use of assisted reproductive technology, such as in vitro fertilization (IVF)

About one half of all women who have an ectopic pregnancy do not have known risk factors. Sexually active women should be alert to changes in their bodies, especially if they experience symptoms of an ectopic pregnancy.

What are the symptoms of ectopic pregnancy?

At first, an ectopic pregnancy may feel like a typical pregnancy with some of the same signs, such as a missed menstrual period, tender breasts, or an upset stomach. Other signs may include

  • abnormal vaginal bleeding
  • low back pain
  • mild pain in the abdomen or pelvis
  • mild cramping on one side of the pelvis

At this stage, it may be hard to know if you are experiencing a typical pregnancy or an ectopic pregnancy. Abnormal bleeding and pelvic pain should be reported to your obstetrician–gynecologist (ob-gyn) or other health care professional.

As an ectopic pregnancy grows, more serious symptoms may develop, especially if a fallopian tube ruptures. Symptoms may include the following:

  • Sudden, severe pain in the abdomen or pelvis
  • Shoulder pain
  • Weakness, dizziness, or fainting

A ruptured fallopian tube can cause life-threatening internal bleeding. If you have sudden, severe pain; shoulder pain; or weakness, you should go to an emergency room.

How is ectopic pregnancy diagnosed?

If you do not have the symptoms of a fallopian tube rupture but your ob-gyn or other health care professional suspects you may have ectopic pregnancy, he or she may

  • perform a pelvic exam
  • perform an ultrasound exam to see where the pregnancy is developing
  • test your blood for a pregnancy hormone called human chorionic gonadotropin (hCG)

How is ectopic pregnancy treated?

An ectopic pregnancy cannot move or be moved to the uterus, so it always requires treatment. There are two methods used to treat an ectopic pregnancy: 1) medication and 2) surgery. Several weeks of follow-up are required with each treatment.

What medication is used to treat ectopic pregnancy?

The most common drug used to treat ectopic pregnancy is methotrexate. This drug stops cells from growing, which ends the pregnancy. The pregnancy then is absorbed by the body over 4–6 weeks. This does not require the removal of the fallopian tube.

When is medication used to treat ectopic pregnancy?

Methotrexate may be used if the pregnancy has not ruptured a fallopian tube. Several factors go into the decision to use methotrexate. One of the most important factors is your ability to follow up with blood tests that check your blood levels of hCG. You will not be able to use methotrexate if you are breastfeeding or have certain health problems.

How is methotrexate given?

Methotrexate often is given by injection in one dose. Before you take methotrexate, blood tests will be done to measure the level of hCG and the functions of certain organs. If hCG levels have not decreased enough after the first dose, another dose of methotrexate may be recommended. You will have careful follow-up over time until hCG is no longer found in your blood.

What are possible side effects and risks of taking methotrexate?

Taking methotrexate can have some side effects. Most women have some abdominal pain. Vaginal bleeding or spotting also may occur. Other side effects may include

  • nausea
  • vomiting
  • diarrhea
  • dizziness

It is important to follow up with your ob-gyn or other health care professional until your treatment with methotrexate is complete. The risk of a fallopian tube rupture does not go away until your treatment is over. Seek care right away if you have symptoms of a rupture, including sudden abdominal pain, shoulder pain, or weakness.

Is there anything I should avoid while taking methotrexate?

Yes, during treatment with methotrexate you should avoid the following:

  • Heavy exercise
  • Sexual intercourse
  • Alcohol
  • Vitamins and foods that contain folic acid, including fortified cereal, enriched bread and pasta, peanuts, dark green leafy vegetables, orange juice, and beans
  • Prescription pain medication and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. These medications can affect the way methotrexate works in the body.
  • Foods that produce gas, which can cause discomfort and mask the pain of a possible rupture of a fallopian tube
  • Prolonged exposure to sunlight. Methotrexate can cause sun sensitivity.

When is surgery used to treat ectopic pregnancy?

If the ectopic pregnancy has ruptured a tube, emergency surgery is needed. Sometimes surgery is needed even if the fallopian tube has not ruptured. In these cases, the ectopic pregnancy can be removed from the tube, or the entire tube with the pregnancy can be removed.

How is surgery performed?

Surgery typically is done with laparoscopy. This procedure uses a slender, lighted camera that is inserted through small cuts in the abdomen. It is done in a hospital with general anesthesia.

What are the possible side effects and risks of surgery?

Your ob-gyn or other health care professional will talk with you about the possible side effects and risks of surgery for ectopic pregnancy. These may include pain, fatigue, bleeding, and infection.

How will I feel after treatment?

Whether you were treated with methotrexate or surgery, you may feel tired for several weeks while you recover. You may feel abdominal discomfort or pain. If you have pain that does not respond to over-the-counter medication, talk with your ob-gyn or other health care professional.

It can take time for the level of hCG in your body to drop after treatment for an ectopic pregnancy. You may continue to feel pregnant for a while. It may take a few cycles for your periods to return to normal.

How can I get emotional support after an ectopic pregnancy?

For some women, ectopic pregnancy can be traumatic. You may be dealing with many emotions after an ectopic pregnancy, even if you were not planning to become pregnant. Take time to work through your feelings. Counseling may be helpful. Ask your ob-gyn or other health care professional to recommend a counselor. Online forums also can be a place to get support from other women who have had ectopic pregnancies.

Can an ectopic pregnancy affect future pregnancies?

Once you have had an ectopic pregnancy, you are at higher risk of having another one. During future pregnancies, be alert for signs and symptoms of ectopic pregnancy until your ob-gyn or other health care professional confirms the next pregnancy is growing in the right place.

Glossary

Assisted Reproductive Technology: A group of infertility treatments in which an egg is fertilized with a sperm outside the body; the fertilized egg then is transferred to the uterus.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fallopian Tube: Tube through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Hormone: A substance made in the body by cells or organs that controls the function of cells or organs.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Pelvic Inflammatory Disease: An infection of the uterus, fallopian tubes, and nearby pelvic structures.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

If you have further questions, contact your obstetrician–gynecologist.

FAQ155: Designed as an aid to patients, this document sets forth current information and opinions related to women’s health. The information does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations, taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice, may be appropriate.

Copyright February 2018 by the American College of Obstetricians and Gynecologists

American College of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998