Ectopic pregnancy is a complication in 1-2 % of pregnancies, where the embryo implants or attaches outside the uterus. In 95-97 % of cases it occurs in the fallopian tube, which is why we mostly call it tubal pregnancy. An ectopic pregnancy can also occur in other parts of the body, such as the ovaries, abdominal cavity or rudimentary horn of the uterus.
An ectopic pregnancy cannot proceed normally. An embryo cannot survive in an environment other than the uterus. The development and growth of tissue elsewhere can cause serious complications, even life-threatening ones, if the condition is not treated.
Risk factors
The cause of the development of an ectopic pregnancy is usually not known, but certain factors and diagnoses can increase the risk:
- young woman (<25 years)
- endometriosis, fallopian tube damage
- history of sexually transmitted diseases, especially gonorrhea or chlamydia, which can lead to the formation of scar tissue in the fallopian tubes through inflammation
- abdominal surgery, past surgery on women who have given birth, especially on the fallopian tubes
- past ectopic pregnancy – if a woman experiences an ectopic pregnancy, there is a higher chance that it will happen again
- frequent inflammation caused by the development of pelvic inflammatory disease (PID)
- infertility treatment – some research confirm that women who conceive with the help of MAR procedures are more likely to develop an ectopic pregnancy
- while using an intrauterine device (IUD) as a form of contraception – pregnancy while using an IUD is rare, but if it does occur, it is almost certainly ectopic
- smoking can increase the risk of ectopic pregnancy – the more a woman smokes, the higher the risk
- multiple sexual partners
Diagnosing ectopic pregnancy
Early diagnosis of ectopic pregnancy (around the 7th week of pregnancy) is very important, as it is necessary to prevent rupture of the fallopian tube and internal bleeding, which can be life-threatening. Diagnosing is difficult, because in about half of the cases, women do not notice any specific signs or symptoms, only those common to early pregnancy – missed periods, tender breasts, nausea.
Typical signs or ectopic pregnancy symptoms are:
- pain (in the pelvis, abdomen or in the place where the pregnancy is located)
- absence of menstruation (amenorrhea)
- uterine bleeding (different from typical menstrual bleeding)
Signs or symptoms of complications or of internal bleeding during ectopic pregnancy, which require emergency medical assistance, are:
- severe abdominal or pelvic pain accompanied by vaginal bleeding
- extreme dizziness or fainting
- shoulder pain
The diagnosis is always made with a combination of ultrasound examination and blood sampling for the ß-hCG value , but sometimes the progesterone and estradiol values are also examined. Usually ectopic or tubal pregnancy is anembryonic (does not contain a live embryo), that is why the level of ß-hCG is significantly lower than in a normal pregnancy in the uterus, and there is also no proper increase or doubling of ß-hCG . There is an insufficient increase in value, a standstill or a slight drop. The normal, expected value of ß-hCG and its increase is present only in the case when the fetus is alive (about 8% of cases of ectopic pregnancy).
Treatment in the case of ectopic pregnancy
Depending on the weeks of absence of menstruation and the progress of the ectopic pregnancy, as well as on the levels of ß-hCG and the general clinical condition of the woman, doctors can decide on different methods of treatment:
- passive treatment (detailed monitoring of the woman)
- medication (methotrexate, actinomycin-D, mifepristone)
- surgical (laparoscopy or, if necessary, laparotomy – removal of the fallopian tube)
For passive and medicinal treatment, the pregnancy should be in the fallopian tube, without rupture (pregnancy less than 4 cm), the woman must be clinically stable, without the presence of major problems, and with a sufficiently low ß-hCG value (up to a maximum of 4000 IU/L).