ECTOPIC PREGNANCY

General Information

DEFINITION--A pregnancy that develops outside the uterus. The most common site is in one of the narrow tubes that connect each ovary to the uterus (Fallopian tube). Other sites include the ovary or outside the reproductive organs in the abdominal cavity or the cervix. About 1 in 100 pregnancies is ectopic.

BODY PARTS INVOLVED--Female reproductive system; abdominal cavity.

SEX OR AGE MOST AFFECTED--Females of childbearing age.

SIGNS & SYMPTOMS

Early stages:

• Missed menstrual period or a heavy, painful period.
• Unexplained vaginal spotting or bleeding.
• Lower abdominal pain and cramps.
• Pain in the shoulder (rare).

Late stages:

• Sudden, sharp, severe abdominal pain caused by rupture of the Fallopian tube.
• Dizziness, fainting and shock (paleness, rapid heartbeat, drop in blood pressure and cold sweats). These may precede or accompany pain (sometimes).

CAUSES--An egg from the ovary is fertilized and becomes implanted outside the uterus--usually in the Fallopian tube. As the fertilized egg enlarges, the Fallopian tube stretches and ruptures, causing life-threatening internal bleeding.

RISK INCREASES WITH

• Use of an intrauterine device (IUD) for contraception.
• Previous pelvic infections.
• Adhesions (bands of scar tissue) from previous abdominal surgery.
• Previous tubal pregnancy.
• Previous tubal or uterine surgery.
• History of endometritis.

HOW TO PREVENT

• Use a contraceptive method other than IUD.
• Obtain prompt treatment for pelvic infection.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Laboratory studies, such as a pregnancy test and blood count.
• Surgical diagnostic procedures, such as laparoscopy and culdocentesis, D & C (dilatation and curettage) and exploratory laparotomy (See Glossary for all).
• Ultrasound to outline the fetus (See Glossary).

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Surgery to remove the developing fetus, the placenta and any damaged tissue. If the Fallopian tube cannot be repaired, it is removed. Future normal pregnancy is possible with one Fallopian tube.

POSSIBLE COMPLICATIONS

• Infection.
• Diminished fertility.
• Loss of reproductive organs after complicated surgery.
• Shock and death from internal bleeding.

PROBABLE OUTCOME--An ectopic pregnancy cannot progress to full term or produce a viable fetus. Rupture of an ectopic pregnancy is an emergency requiring immediate hospitalization and surgery. Full recovery is likely with early diagnosis and surgery. Subsequent pregnancies are usually normal.

How To Treat

GENERAL MEASURES----After surgery:

• You may wash normally over the stitches in your incision.
• Use heat to relieve pain. Apply a heating pad or hot-water bottle to the abdomen or back. Hot baths also relieve discomfort and relax muscles. Sit in a tub of hot water for 10 to 15 minutes. Repeat as often as needed.

MEDICATION--Medicine usually is not necessary for this disorder.

ACTIVITY--Resume your normal activities, including sexual relations, as soon as possible. Frequent, satisfying sexual activity helps you feel closer to your mate and promotes healing. Attempt sexual intercourse soon, but provide adequate lubrication. Spend extra time touching, conversing intimately and caressing. During early encounters, the woman must decide how much penile penetration and vigorous thrusting is comfortable.

DIET--No special diet.

Call Your Doctor If

• You have symptoms of ectopic pregnancy, especially a rupture. Call immediately. This is an emergency!
• The following occurs after surgery: Excessive vaginal bleeding (soaking a pad or tampon every hour). Signs of infection, such as fever, chills, headache, dizziness or muscle aches. Increased urinary frequency that lasts longer than 1 month. This may be a sign of bladder irritation or infection resulting from surgery.