Ectopic pregnancy

Definition

An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus).

Alternative Names

Tubal pregnancy; Cervical pregnancy; Tubal ligation - ectopic pregnancy

Causes

In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include:

The following also increase risk for an ectopic pregnancy:

Sometimes, the cause is not known. Hormones may play a role.

The most common site for an ectopic pregnancy is the fallopian tube. In rare cases, this can occur in the ovary, abdomen, or cervix.

An ectopic pregnancy can occur even if you use birth control.

Symptoms

Symptoms of ectopic pregnancy may include:

If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:

Exams and Tests

The health care provider will do a pelvic exam. The exam may show tenderness in the pelvic area.

A pregnancy test and vaginal ultrasound will be done.

Human chorionic gonadotropin (hCG) is a hormone that is produced during pregnancy. Checking the blood level of this hormone can detect pregnancy.

You may need more than one exam, ultrasound, and blood test. Your provider will instruct you about signs to watch for until your next visit.

Treatment

Ectopic pregnancy may be life threatening. The pregnancy cannot continue to birth (term).  Effective treatment requires either medical treatment to end the pregnancy or surgical removal of the pregnancy.

If the ectopic pregnancy has not ruptured, treatment may include:

You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock. Treatment for shock may include:

If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the doctor may have to remove the fallopian tube.

Outlook (Prognosis)

If diagnosed early, treatment is very effective. It's important to seek early care whenever you believe you may be pregnant so your provider may determine the location of the pregnancy.

One out of three women who have had one ectopic pregnancy can have a baby in the future. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again.

The likelihood of a successful pregnancy after an ectopic pregnancy depends on:

When to Contact a Medical Professional

Contact your provider if you have:

Prevention

Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. You may be able to reduce your risk by avoiding conditions that may scar the fallopian tubes. These steps include:

References

Alur-Gupta S, Cooney LG, Senapati S, Sammel MD, Barnhart KT. Two-dose versus single-dose methotrexate for treatment of ectopic pregnancy: a meta-analysis. Am J Obstet Gynecol. 2019;221(2):95-108.e2. PMID: 30629908 pubmed.ncbi.nlm.nih.gov/30629908/.

Henn MC, Lall MD. Complications of pregnancy. In: Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 173.

Hur HC, Lobo RA.. Ectopic pregnancy: etiology, pathology, diagnosis, management, fertility prognosis. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 17.

Nelson AL, Gambone JC. Ectopic pregnancy. In: Hacker NF, Gambone JC, Hobel CJ, eds. Hacker & Moore's Essentials of Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2016:chap 24.


Review Date: 1/10/2022
Reviewed By: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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