97% of ectopic pregnancies occur in the Fallopian tubes.
Ectopic pregnancies make up approximately 1% of pregnancies.
Factors that increase the risk of having an ectopic pregnancy include:
Aside from those mentioned below, other symptoms of ectopic pregnancy include:
When an ectopic pregnancy is present, the signs are not always obvious. It should always be considered as a possibility in women of reproductive age.
A differential diagnosis should consider 'threatened miscarriage' and ectopic pregnancy. In the former, vaginal bleeding is the main symptom and pain may come later as the cervix dilates. In ectopic pregnancies, the pain usually comes first and vaginal bleeding is less significant – and sometimes absent.
Human chorionic gonadotrophin (hCG) levels are often tested. Conservative management may be appropriate if the levels of hCG are falling and the patient is clinically well.
Note: Due to increased risk of rupture of an ectopic pregnancy following palpation, internal examination should normally be avoided if ectopic pregnancy is suspected. The safest and most accurate method for detecting an ectopic pregnancy is transvaginal ultrasound: it can identify the location of the pregnancy and even detect any fetal heartbeat.
Single-dose methotrexate treatment appears to be as effective as surgery. It can be used in cases where there is no significant pain, the ectopic pregnancy has not ruptured, the adnexal mass is < 35mm in size, there is no detectable fetal heartbeat, no normal (intrauterine) pregnancy can be seen on an ultrasound scan, and serum hCG < 1500 IU/L. A repeat injection may be required, and there are some side-effects to be aware of.
In other cases, laparoscopic surgery is generally used.
When detected sufficiently early, prognosis is excellent. Most women are now diagnosed before tubal rupture, which results in a much improved outcome – including tubal preservation and the potential for future fertility.
In the West, only about 1-in-500 cases of ectopic pregnancy result in maternal death, with most of these being the result of substandard care.
Following an ectopic pregnancy, the risk of another ectopic pregnancy is about 10-20% and the chance of a successful intrauterine pregnancy is about 70%.
Common surgical complications are also a possibility.
Women with a confirmed pregnancy should seek immediate medical attention if any of the following symptoms are present:
If the ectopic pregnancy has ruptured, profuse bleeding will occur. This may lead to excess blood loss and symptoms of hypovolemic shock (hemorrhagic shock), including dizziness upon standing.
The chances of developing an ectopic pregnancy are significantly increased in women who have already had one.
A second trimester unruptured tubal pregnancy is a rare – but nevertheless possible – occurrence.
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