Women's Health: Diagnosing and Treating Ectopic Pregnancy

Women's Health
Diagnosing and Treating Ectopic Pregnancy
by Kenneth L. Noller, MD
President, The American College of Obstetricians and Gynecologists

About one out of every 50 preg-nancies are ectopic (sometimes called tubal) in the US, and it is the leading cause of pregnancy-related death during the first three months of pregnancy.
Ectopic pregnancy occurs when a fertilized egg implants itself in a woman's fallopian tube, or elsewhere in the abdomen, instead of the uterus. Because it takes place outside the uterus, the pregnancy will not progress as it would naturally and must be removed.
The No. 1 risk factor for an ectopic pregnancy is a prior case of pelvic inflammatory disease, especially when caused by a current or previous chlamydia infection. Other risk factors include prior ectopic pregnancy or tubal surgery, cigarette smoking, a woman's exposure to diethylstilbestrol, past infertility, and increasing age.
You may feel the effects of an ectopic pregnancy before you know that you are pregnant. If you are sexually active and of childbearing age, call your doctor if you experience abnormal vaginal bleeding (not related to a menstrual period) or sudden or sharp abdominal or pelvic pain that aches without relief or that seems to come and go. If your fallopian tube bursts, blood may build up in the abdomen, causing pain in the shoulder or weakness, dizziness, or fainting from blood loss.
To diagnose an ectopic pregnancy, your doctor may perform a pelvic exam or an ultrasound, give you a blood test to detect pregnancy hormones, or take your blood pressure (low blood pressure may be a sign of internal bleeding).
If an ectopic pregnancy is caught early enough, you and your doctor may be able to choose a treatment that will save the affected tube before it bursts and possibly preserve your future fertility.
You may be given the drug methotrexate, which will stop the pregnancy and allow the body to absorb it over time. Small ectopic pregnancies also can be removed surgically. During surgery, your doctor can check for and treat any internal bleeding. Your doctor may be able to repair a fallopian tube that has not been too extensively damaged, providing a good chance that you will be able to have a healthy pregnancy later.
If the fallopian tube ruptures, however, it is an emergency. You may be bleeding heavily, and immediate surgery to remove the affected tube will be necessary.
Women who have had an ectopic pregnancy should allow time for both physical and emotional healing. Counseling may help you and your partner in the grieving process. Ask your doctor to assist you in finding appropriate counselors or support groups.
For more information, the Patient Education Pamphlet "Ectopic Pregnancy" is available in English and Spanish at www.acog.org/publications/patient_education.