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An ectopic pregnancy occurs when the fertilized egg implants and starts to grow in a place other than the uterus. In 97% of cases this is the Fallopian tube and because of this ectopics are frequently referred to as tubal pregnancies. However, sometimes the egg will implant on the ovary or cervix or even in the abdominal cavity.
The most common reason for ectopic pregnancy is damage to the Fallopian tubes which is most often caused by pelvic inflammatory disease, although there are other causes such as pelvic surgery and endometriosis.
Ectopic pregnancy is both common and very serious for if left untreated it can lead to massive internal bleeding and even death. Fortunately, in 80% of cases the diagnosis is made before rupture of the tube occurs.
Diagnosis
Ectopic pregnancies are sometimes difficult to diagnose but should be suspected if a woman has a history of late menses (the majority present after 8 weeks of amenorrhoea) irregular vaginal bleeding or abdominal pain. Shoulder pain and a feeling of rectal pressure can sometimes also occur but some women have no symptoms (other than those of early pregnancy) which makes diagnosis difficult.
If an ectopic pregnancy is suspected it can often be confirmed by checking hormone levels (HCG) which are different in abnormal and normal pregnancies. Pelvic ultrasound scans are also often used to make a diagnosis.
Treatment
If an ectopic pregnancy is diagnosed before rupture has occurred medical management may be a possibility. This involves the injection of the drug methotrexate which halts the division of the fertilized cells.
If rupture has occurred the pregnancy is removed with part or all of the damaged tube using endoscopic (keyhole) surgery. Sometimes a laparotomy (opening of the abdomen) will be necessary if bleeding is severe. The ovary is generally preserved.
Future pregnancies
There is an approximately 12% recurrence rate of an ectopic pregnancy so women with a previous history should be closely monitored in early pregnancy using HCG testing and ultrasound scanning.
