What is tubal or ectopic pregnancy?

An ectopic pregnancy is a pregnancy that takes place outside the uterus.

The most common site of an ectopic pregnancy is one of the fallopian tubes.

An ectopic pregnancy in the fallopian tubes is called a tubal pregnancy.

Sometimes the pregnancy develops in the ovary and, rarely, in the abdominal cavity or cervix.

An ectopic pregnancy threatens the life of the mother and must be ended as soon as possible.

HOW DOES IT OCCUR?

An ectopic pregnancy is usually associated with some condition that blocks the passage of the fertilized egg into the uterus. These conditions include:

• a previous infection that caused scar tissue to form in the fallopian tubes
  
• surgery on the tubes, ovaries, or a ruptured appendix
  
• a previous ectopic pregnancy
  
• a pelvic tumor that interferes with the fallopian tubes
  
• certain birth control methods, such as IUDs.
  
• you have a greater chance of having an ectopic pregnancy if your mother was exposed to DES

WHAT ARE THE SYMPTOMS?

Ectopic pregnancies are usually diagnosed within the first 2 months of pregnancy, possibly before a woman realizes that she is pregnant.

The symptoms may be mild or they may be severe and dangerous.

They can be the same as the symptoms of early pregnancy or other less serious conditions.

Possible symptoms of an ectopic pregnancy are:

• missed period or abnormal vaginal bleeding
  
• pain in the lower abdomen or pelvis
  
• symptoms of pregnancy such as breast tenderness, morning sickness, etc.

Rupture of an ectopic pregnancy is life threatening.

The symptoms include:

• sudden increase in pain
  
• symptoms of oncoming shock: pale skin, fast heart rate, and dizziness and possible fainting from low blood pressure caused by bleeding
  
• shoulder pain from irritation of the diaphragm caused by bleeding into the abdomen.

HOW IS IT DIAGNOSED?

Certain blood tests can detect an ectopic pregnancy before symptoms develop.

In addition to blood tests and a pregnancy test, the following procedures may be done:

• Ultrasound scan to see if the fertilized egg is in the uterus or a fallopian tube.
  
• Laparoscopy, which is the insertion of a lighted instrument into the abdomen through an incision in the bellybutton to look at the pelvis and tubes. An ectopic pregnancy can be seen even before it ruptures and may be removed with laparoscopy instruments.

HOW IS IT TREATED?

If an ectopic pregnancy is diagnosed very early in pregnancy (within the first 6 weeks of pregnancy), it can be treated with medication (methotrexate).

Otherwise, the doctor will perform surgery to remove the pregnancy. In some cases this surgery can be done through a laparoscope.

Abdominal surgery (laparotomy) may be needed if there is heavy bleeding into the abdomen and if the fallopian tube has ruptured and needs repair. Any damaged tissue, such as all or part of a fallopian tube, will be repaired or removed.

If you are in shock and very sick or unstable, you must have surgery immediately to stop internal bleeding.

If you lose a lot of blood, you may need blood transfusions.