Abdominal pregnancy

Definition

An ectopic pregnancy is an abnormal pregnancy that occurs outside the uterus (womb). The baby can not survive.

Alternative Names

Causes

An ectopic pregnancy occurs when baby starts to develop outside the womb (uterus). The most common site for an ectopic pregnancy is within a fallopian tube. However, in rare cases, ectopic pregnancies can occur in the ovary, the stomach area, and the cervix.

An ectopic pregnancy is usually caused by a condition that blocks of slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube.

Most cases are a result of scarring caused by a past infection in the fallopian tubes, surgery of the fallopian tubes, or a previous ectopic pregnancy. Up to 50% of women who have ectopic pregnancies have had inflammation of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID).

Some ectopic pregnancies can be due to birth defects of the fallopian tubes, endometriosis, complications of a ruptured appendix, or scarring caused by previous pelvic surgery. In a few cases, the cause is unknown.

Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). The risk of an ectopic pregnancy due to this procedure may reach 60%. Women who have had successful surgery to reverse tubal sterilization in order to become pregnant also have an increased risk of ectopic pregnancy.

Taking hormones, specifically estrogen and progesterone (such as those in birth control pills), can slow the normal movement of the fertilized egg through the tubes and lead to ectopic pregnancy.

Women who have in vitro fertilization or who have an intrauterine device (IUD) using progesterone also have an increased risk of ectopic pregnancy.

The "morning after pill" (emergency contraception) has been linked to some cases of ectopic pregnancy.

Ectopic pregnancies occur from 1 in every 40 to 1 in every 100 pregnancies.

Symptoms

• Lower abdominal or pelvic pain
• Mild cramping on one side of the pelvis
• Amenorrhea (missed period)
• Abnormal vaginal bleeding (usually spotting)
• Breast tenderness
• Nausea
• Low back pain

If the area of the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:

• Severe, sharp, and sudden pain in the lower abdominal area
• Feeling faint or actually fainting
• Referred pain to the shoulder area

Internal bleeding due to a rupture may lead to shock. This is the first symptom of nearly 20% of ectopic pregnancies.

Exams and Tests

The health care provider will perform a pelvic exam, which may reveal tenderness in the pelvic area. A pregnancy test is usually positive (says you are pregnant).

Tests that may be done include:

• Hematocrit (may be normal or high)
• White blood count (may be normal or high) 
• Culdocentesis (to check for blood in the pelvic/abdomen area) 
• Transvaginal ultrasound or pregnancy ultrasound (shows an empty uterus)

A laparoscopy, laparotomy, or D and C may be needed to confirm the diagnosis.

An ectopic pregnancy may affect the results of a serum progesterone test.

Treatment

Ectopic pregnancies cannot continue to term (birth), so the developing cells must be removed to save the mother's life.

Emergency medical help is needed if the area of the ectopic pregnancy ruptured. (Shock is an emergency condition.) Treatment for shock may include keeping the woman warm, raising her legs, and giving oxygen. Fluids by IV and a blood transfusion may be needed.

Surgery (laparotomy) is done to stop blood loss (in the event of a rupture). This surgery is also done to confirm the diagnosis of ectopic pregnancy, remove the abnormal pregnancy, and repair any tissue damage. In some cases, removal of the fallopian tube may be necessary.

A mini-laparotomy and laparoscopy are the most common surgical treatments for an ectopic pregnancy that has not ruptured. In cases where the doctor does not think a rupture will occur, the woman may be given a medicine called methotrexate is given and monitored. Blood tests and liver function tests may be done.

Outlook (Prognosis)

About 85% of the women who have had one ectopic pregnancy are later able to have a normal pregnancy. A repeated ectopic pregnancy may occur in 10 - 20% of cases. Some women do not become pregnant again, while others become pregnant and spontaneously abort (lose the baby) during the first 3 months.

The rate of a woman in the United States who die due to an ectopic pregnancy has dropped in the last 30 years to less than 0.1%.

Possible Complications

The most common complication is rupture with internal bleeding that leads to shock. Death from rupture is rare. Infertility

When to Contact a Medical Professional

A woman who has symptoms of ectopic pregnancy (especially lower abdominal pain or abnormal vaginal bleeding) should call her health care provider. Ectopic pregnancy can occur in any woman who is fertile and sexually active, regardless of contraceptive use.

Prevention

Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. However, a tubal pregnancy (the most common type of ectopic pregnancy) may be prevented in some cases by avoiding conditions that might scar the fallopian tubes. The following may reduce the risk of a tubal pregnancy:

• Avoiding risk factors for pelvic inflammatory disease (PID), such as multiple sexual partners, intercourse without a condom, and sexually transmitted diseases (STDs)
• Early diagnosis and treatment of STDs
• Early diagnosis and treatment of salpingitis and PID

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Nielsen CL, Miller L. Ectopic gestation following emergency contraceptive pill administration. Contraception. 2000 Nov;62(5):275-6.

Furlong LA. Ectopic pregnancy risk when contraception fails. A review. J Reprod Med. 2002 Nov;47(11):881-5. Review.