An ectopic pregnancy is a pregnancy that develops outside a woman’s uterus (womb). This happens when the fertilized egg from the ovary does not implant itself normally in the uterus. The egg settles in the fallopian tubes more than 95% of the time. This is why ectopic pregnancies are commonly called “tubal pregnancies.” The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies. About one in every 40 to 100 pregnancies is ectopic. Ectopic pregnancies are possible in the abdomen, ovary or neck of the uterus (cervix) as well.
Many factors are known to increase the risk of having an ectopic pregnancy. Anything that alters the tubal function may affect further pregnancies. Fallopian tubes aren’t like a hollow pipe that sits there with the egg rolling down. They have little hairs on the inside (cilia) which move with a wave-like motion to encourage the egg toward the womb. The greatest risk factor for an ectopic pregnancy is a prior history of an ectopic pregnancy. The recurrence rate is 15% after the first ectopic pregnancy, and 30% after the second.
More serious signs of ectopic pregnancy are pain and vaginal bleeding. You also may feel a sharp or stabbing pain in your stomach or on one side of your pelvis.
Ectopic pregnancies can be difficult to identify because they usually cause normal early pregnancy symptoms such as a missed menstrual period, fatigue, breast tenderness, and nausea. Abnormal vaginal bleeding is common, too. If the fallopian tube ruptures, you may feel sharp, stabbing pain in your pelvis, abdomen or even your shoulder and neck. You may become dizzy or faint.
Laparoscopy was the gold standard method for diagnosis of ectopic pregnancy and is still the method of choice where there are no facilities for performing the blood tests and ultrasound scanning; a laparoscopy will be advised to inspect the Fallopian tube and ovaries.
If the tube has become stretched or it has ruptured and started bleeding, all or part of the fallopian tube may have to be removed. Bleeding needs to be stopped promptly and emergency surgery is needed.
A biopsy, in which a tissue sample is removed and analyzed, is performed to distinguish between ulcers and cancer and to evaluate the presence of mast cells, which are sometimes seen in abundance in IC-affected bladders.
For more advanced gestations, intratubal injection (under laparoscopic and ultrasonic guidance) of methotrexate, potassium chloride or prostaglandin F has also been used.