Ectopic pregnancy: Symptoms, causes, risks and treatment

Usually an ectopic pregnancy occurs in the fallopian tube, but it can also occur in the "tube" of the uterus, the ovaries, or the abdominal cavity.

In a normal pregnancy, fertilization occurs in the fallopian tubes, where an egg meets a sperm cell. The fertilized egg travels to the uterus and "settles" in the lining of the uterus. The egg develops into an embryo and remains in the uterus until birth.

An ectopic pregnancy can be fatal without immediate treatment. For example, the fallopian tube can burst, causing internal abdominal bleeding, shock and severe blood loss.

According to the US Centers for Disease Control and Prevention (CDC), the chance of an ectopic pregnancy is 1-2%, while the condition is the cause of 3-4% of pregnancy-related deaths.

Ectopic pregnancy: Symptoms

At first, an ectopic pregnancy appears similar to a normal pregnancy. The woman will have a positive pregnancy test. Then she will "miss" a menstrual cycle and may experience nausea. Her breasts will become more sensitive and she may experience fatigue. After 4-10 weeks of ectopic pregnancy, however, symptoms will begin to indicate an abnormal pregnancy.

These symptoms may include:

• Pain on one side of abdomen: This can be acute and lasting.
• Vaginal bleeding: The blood will be lighter in color, or darker than during menstrual bleeding and usually less viscous. If a woman does not know she is pregnant, she may mistake vaginal bleeding for menstrual blood.
• Pain in the edge of the shoulder: This is a common sign of internal bleeding. Bleeding can irritate the phrenic nerve and this leads to shoulder pain.
• Pain during urination, or defecation: This can also indicate an ectopic pregnancy.
• Fainting, or collapse: If the fallopian tubes rupture, this can cause fainting and collapse. This is a medical emergency.

Other signs of internal bleeding include:

• dizziness
• faint
• diarrhea
• pale skin

The rupture of the "tube" of the uterus can occur after 6-16 weeks of pregnancy. However, it can be successfully treated by your doctor.

A fertilized egg cannot survive outside the uterus and therefore will not survive an ectopic pregnancy. The pregnancy cannot be saved.

Ectopic pregnancy: Complications

A complication of ectopic pregnancy is more likely if diagnosis or treatment is delayed, or if the condition is never diagnosed.

• Internal bleeding: A woman who has an ectopic pregnancy and does not receive early diagnosis or treatment is more likely to experience severe internal bleeding. This can lead to shock and serious complications for her health.
• Fallopian tube damage: Delayed treatment can also damage the fallopian tubes, greatly increasing the risk of future ectopic pregnancy.
• Depression: This may be due to grief over pregnancy loss and worry about future pregnancies.

It is important to remember that pregnancy is still possible even if one fallopian tube is removed. If both tubes are removed, artificial insemination remains an option if the woman wishes to conceive.

Ectopic pregnancy: Risk factors

The following factors are the main ones that lead to a higher risk of an ectopic pregnancy:

• Previous ectopic pregnancy: Women who have already had an ectopic pregnancy have a 10% increased risk of a subsequent one.
• Age: The older a woman is when she becomes pregnant, the greater the risk of an ectopic pregnancy.
• Infection: A possible history of inflammation and infection of the fallopian tubes, uterus, or ovaries may increase the risk of subsequent ectopic pregnancies. Infections associated with ectopic pregnancy include pelvic inflammatory disease (PID) and salpingitis. About 50% of ectopic pregnancies are associated with salpingitis.
• Sexually Transmitted Diseases (STDs): Certain STDs) increase the risk of VND. Such are gonorrhea and chlamydia.

However, there are also the following risk factors:

• Smoking: Has been associated with increased chances of ectopic pregnancy.
• Fertility treatment: Medicines used to stimulate ovulation during fertility treatment have been linked to a higher chance of an ectopic pregnancy.
• Problematic or abnormal fallopian tubes: This can be caused by surgery, for example, and can mean a higher risk of an ectopic pregnancy.
• Previous surgery: Previous surgery and surgery to remove fibroids are risk factors for ectopic pregnancy.
• Taking birth control pills, or an intrauterine method of contraception: Both can increase the risk of ectopic pregnancy.
• Tubing connection: Tubal ligation is a surgical procedure that a woman undergoes to prevent further pregnancy. If she becomes pregnant right away, then the pregnancy is more likely to be ectopic.

However, it is possible for a woman to have an ectopic pregnancy without any of the above risk factors.