A pregnancy that develops and occurs outside the uterus, most often in a fallopian tube, but occasionally in an ovary, the cervix, or abdominal cavity. As the pregnancy continues to develop, it can cause damage to surrounding tissues, causing serious bleeding. An ectopic pregnancy can be potentially life threatening and always requires emergency treatment.
The fertilised ovum (egg) can become stuck in the fallopian tube if there is a congenital abnormality of the tube or if the tube has been damaged in any way. Damage is often due to a pelvic infection or from surgery on the fallopian tubes. Ectopic pregnancy has also been associated with the use of some types of IUD and progestogen only oral contraceptives.
The vast majority of ectopic pregnancies are found in the first two months, generally before the woman even realises that she is pregnant. Symptoms can include severe pain the lower abdomen and bleeding from the vagina. Internal bleeding can cause symptoms of shock which include faintness, sweating and pallor.
Diagnosis and treatment
A blood test can be carried out to measure levels of human chorionic gonadotrophin (HCG); this hormone is produced naturally in pregnancy but in lower amounts if the pregnancy is ectopic. A transvaginal ultrasound examination can also be done, which involves inserting an ultrasound probe through the vagina, and, in some cases, a laparoscopy (internal examination with the use of a viewing instrument).
If the diagnosis is made early enough, treatment using the drug methotrexate can be considered. In many cases, surgery, usually minimally invasive surgery, is carried out to remove the embryo (which is often already dead), the placenta, and any damaged tissue at the site of the pregnancy. If blood loss is high, blood transfusions and/or a laparotomy can be necessary. An affected fallopian tube is taken out if it cannot be repaired.
It is still possible to have a normal pregnancy even if one fallopian tube has been removed, however, the chances of conception will be slightly reduced. Women with two damaged tubes can require invitro fertilisation to achieve an intrauterine pregnancy.