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Ectopic pregnancy    See images

Overview | Symptoms | Treatment | Prevention

Alternative names:

Tubal pregnancy; Cervical pregnancy; Abdominal pregnancy

Treatment

In the event that pelvic-organ rupture has occurred because of the ectopic pregnancy, internal bleeding and/or hemorrhage may lead to shock. Nearly 20% of ectopic pregnancies present themselves in this manner. This is an emergency condition. Therefore, initial treatment may be to address shock by keeping the woman warm, elevating her legs, and administering oxygen. Treatment with intravenous fluids and sometimes a blood transfusion is performed as soon as possible.

Surgical laparotomy is performed to stop the immediate loss of blood (in cases in which rupture has already occurred), or to confirm the diagnosis of ectopic pregnancy, remove the products of conception, and repair surrounding tissue damage as much as possible.

In non-emergency cases, mini-laparotomy or laparoscopy are the most common surgical treatments. Such procedures have similar outcomes. However, they are less invasive and are available at a lower cost because they require minimal hospitalization or outpatient treatment.

Non-surgical (medical) management is being implemented in many medical centers for ectopic pregnancies without suspected immediate danger of rupture. In such cases, methotrexate is administered with careful outpatient monitoring of the woman and serial quantitative HCGs and CBCs.

Prognosis

About 85% of the women who have experienced one ectopic pregnancy are later able to achieve a normal pregnancy. A subsequent ectopic pregnancy may occur in 10 to 20 % of cases. Some women fail to become pregnant again, while others become pregnant and spontaneously abort during the first trimester. The maternal death rate from ectopic pregnancy in the U.S. has decreased in the last 30 years to less than 0.1%. Fetal death rate is nearly 100%.

Complications

• Rupture, with resulting hemorrhage leading to shock and the risk of requiring a blood transfusion or rarely of death, is the most common complication.
• Infertility occurs in 10 to 15% of women who have experienced an ectopic pregnancy.

Call Your Health Care Provider If:

A woman who has an early pregnancy or who has had the opportunity to become pregnant and has symptoms (especially lower abdominal pain and/or abnormal vaginal bleeding) should notify her health care provider. Ectopic pregnancy can occur in any woman who is sexually active, regardless of contraceptive use.

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