In normal pregnancies, a fertilized egg becomes attached to the wall of uterus. In some cases, the egg attaches outside of the uterus, usually in the fallopian tube. This is called an ectopic pregnancy. Ectopic pregnancies are fairly common, happening in one out of every sixty pregnancies. Unfortunately, ectopic pregnancies must be terminated as the tubes are not able to support the growth of a baby.
Ectopic pregnancies are generally caused by some sort of abnormality in the fallopian tube. A tube can become partially or completely blocked if there has been a previous infection. Adhesions or scar tissue caused by previous surgeries can also cause damage to the tubes. Some women are born with tubes that are not normal. Sometimes there is no apparent cause for the ectopic pregnancy to occur. Women who have had abdominal surgery, pelvic inflammatory disease, or multiple abortions are more likely to develop an ectopic pregnancy. There is also a greater risk for women who are in their late thirties or older at the time of their pregnancy. Women who have had one ectopic pregnancy are at greater risk for having a second.
Most women do not know their pregnancy is ectopic until they start to have symptoms. Ectopic pregnancies will cause a woman to have a positive pregnancy test. If a doctor is monitoring the level of hCG, the pregnancy hormone, an ectopic pregnancy might be diagnosed because of lower than normal hCG levels. Generally, a woman will start having symptoms as the pregnancy develops that will indicate that an ectopic pregnancy is occurring. The most common symptom is sharp pain in the pelvic area, stomach, shoulders or neck. The pain can be quite intense, but it will often come and go. Nausea and vomiting are common. Women suffering from an ectopic pregnancy can experience vaginal bleeding which can be quite heavy. They might faint, or complain of being weak or dizzy.
The earlier an ectopic pregnancy is diagnosed, the better. A doctor will diagnose an ectopic pregnancy by monitoring hCG levels, performing an ultrasound to see if anything can be seen in the uterus, and by performing a pelvic exam. A procedure called a culdocentesis might be performed to check for the presence of blood behind the uterus which might indicate an ectopic pregnancy.
Once a pregnancy has been determined to be ectopic, it is impossible to save. The focus will be on saving the fallopian tubes and minimizing damage. If the pregnancy is not too far along, doctors will administer methotrexate. It is used to encourage the body to absorb the tissue from the pregnancy. However, if there is significant bleeding or the fallopian tube has become damaged, surgery will be performed. The patient will undergo laparoscopic surgery, or may need a laparoscopy. The surgeon will remove the pregnancy and attempt to save the fallopian tube. If it is too damaged, he will remove the tube during the surgery. The level of hCG will be monitored to ensure that all of the pregnancy tissue was removed.
Losing a pregnancy because it was ectopic can be very difficult emotionally for a woman. Counselling might be appropriate to help her deal with her loss. Friends and family members should understand that it can be devastating for a woman to lose a pregnancy in this manner and should be supportive. Having an ectopic pregnancy does not mean that a woman can not have a successful pregnancy in the future. After the patient has recovered, her doctor can discuss possible options for another pregnancy. Many women go on become pregnant and carry a baby to term without complications.