to Dr. Tarek Khalife, a Mayo Clinic Health System OB-GYN
physician, ectopic pregnancies are rare. However, he says in
the off chance an ectopic pregnancy is discovered, itís a
situation that must be taken seriously. Often, patients have
questions and are looking for answers to understand this
pregnancy occurs when a fertilized egg attaches itself outside
of the uterus," says Khalife. "Ninety percent of the
time, it attaches to the fallopian tube. However, in other
instances, it can attach to the ovary, cesarean section scar,
cervix or even the abdomen. If attached to the abdomen, the
danger of complications is significantly increased."
rare for an ectopic pregnancy to coexist with another normal
intrauterine pregnancy; yet, itís still possible and poses
critical challenges in diagnosis and treatment. Luckily, itís
an uncommon event, except in patients receiving fertility
treatments, where the prevalence is a ratio of 1 in 100, as
compared to 1 in 30,000 in spontaneous pregnancies.
pregnancies donít have specific symptoms and can be easily
missed if the health care provider fails to keep it in mind.
Ectopic pregnancy-related symptoms vary between showing no
symptoms at all, especially during the early stages, to severe
lower abdominal pain with dizziness caused by massive internal
and symptoms also vary depending on the location of the
ectopic implantation. Khalife says commonly reported symptoms
of ectopic pregnancies include vaginal spotting and vague
lower-abdominal or pelvic pain.
vaginal spotting and vague lower-abdominal or pelvic pain can
mimic the same symptoms as patients with normal pregnancies.
is why itís important to track your periods," explains
Khalife. "When you miss your period, especially if youíre
not on reliable birth control, you should perform a pregnancy
test and follow up with your health care provider as soon as
possible. This helps you document a potential pregnancyís
location and viability at around five to six weeks of
gestation, and increases the chance of early diagnosis and
treatment of an ectopic pregnancy.
sure to visit your health care provider even sooner if you
experience abnormal bleeding or pain with a positive pregnancy
test, as this could be the early signs of an impending
pregnancy is diagnosed when the gestational sac with a live
fetal pole or yolk sac is found outside an empty uterine
cavity," says Khalife. "Sometimes, diagnosis can be
challenging if the ectopic pregnancy is in its early stage and
the sac is not yet visible by ultrasound."
scenarios, Khalife says pregnancy hormone levels are monitored
for the rate of rise, which tends to be abnormal in cases of
pregnancy in ectopic implantations. Rarely, when pregnancy
hormones are not rising normally and the location of the
ectopic pregnancy is not confidently identified despite serial
follow-up ultrasounds and pregnancy hormone testing,
aspiration of the uterine cavity is performed to rule out an
abnormal uterine pregnancy.
FOR ECTOPIC PREGNANCY
of ectopic pregnancy depends on the gestational age, symptoms
and location of the gestational sac. Advanced ectopic
pregnancy usually presents with rupture, pain or severe
bleeding. In these situations, surgical treatments often are
indicated for surgical removal of the pregnancy and control of
bleeding to protect the mother.
ectopic pregnancy is diagnosed early and before the onset of
symptoms, a medication can be used to stop the growth of the
pregnancy and allow the body to absorb it without removing the
case of a tubal pregnancy, surgical treatments include
laparoscopic surgery to remove the ectopic tissue and repair
the fallopian tube.
the fallopian Khalife. "The condition of the fallopian
tube and degree of damage by the ectopic pregnancy usually
determines the recommended approach."
FACTORS FOR ECTOPIC PREGNANCY
in mind that about half of ectopic pregnancies occur in
patients who have no known risk factors, things that increase
the risk of ectopic pregnancy are those that affect the free
passage of the fertilized egg from getting into the uterine
cavity. This may include:
Scarred or interrupted fallopian tube, whether due to prior
surgery or infection (most commonly chlamydia)
Pregnancies that are a product of infertility treatment
prior ectopic pregnancy
AND SUPPORT AFTER ECTOPIC PREGNANCY
pregnancy is a pregnancy where an embryo is formed, and,
hence, the emotional toll of this loss on the patient and her
family rivals the experience of patients who experience a
miscarriage or neonatal loss. Add to that the possibility of
losing an organ such as the fallopian tube and the anxiety of
not being able to conceive in the future. The process of grief
after a pregnancy loss could take several weeks. The patient
might feel numb, sad, guilty, angry and apprehensive about the
patient needs to understand that itís normal to feel this
way," says Khalife. "Health providers who take care
of women who go through this experience should make sure to
screen for abnormal grief and to rule out post-pregnancy loss
depression and psychosis, and provide empathic and
are instructed to continue to take care of themselves with:
Avoidance of drugs, alcohol and smoking that might negatively
affect the grieving process
patients who experience ectopic pregnancy and treatment will
achieve a successful pregnancy in the future ó even if theyíve
lost one fallopian tube as part of the therapy. There is a 10
percent risk of recurrence, which is why itís important to
work with your provider when planning for a future pregnancy.
Also, early documentation of an intrauterine gestational sac
is of paramount importance.
OF CONCEIVING AFTER ECTOPIC PREGNANCY
fertility treatments are risk factors for ectopic pregnancy
and ectopic pregnancy is a risk factor for another ectopic
pregnancy, treatment of ectopic pregnancy and its effect on
fertility is a complex issue.
that have looked at the difference in fertility after
treatment of ectopic pregnancy showed that medical treatment
of early ectopic pregnancies with medication, compared to
fallopian tube-sparing surgical treatment, had no adverse
patients who were treated with fallopian tube-sparing surgery
and fallopian tube removal surgery had almost the same rate of
pregnancy after treatment if the other fallopian tube was
the event that the other fallopian tube is either damaged or
absent, itís better to try to spare the fallopian tube to
maximize fertility potential, with the slight increased risk
of recurrence," explains Khalife. "In the event of
severe damage of the tube and need for its removal, the
patientís reproductive potential with no functional
fallopian tubes will be severely compromised. If this is the
case, fertility treatments like in vitro fertilization will be
the only way to achieve pregnancy."