Although pregnancy is rare after a tubal ligation or with an intrauterine device IUD , those pregnancies that do develop may have an increased chance of being ectopic. An early ectopic pregnancy often feels like a normal pregnancy. A woman with an ectopic pregnancy may experience common signs of early pregnancy, such as:.
First signs of an ectopic pregnancy may include:. As an ectopic pregnancy progresses, though, other symptoms may develop, including:. Symptoms of miscarriage often are similar to symptoms experienced in early ectopic pregnancy.
For more information, see the topic Miscarriage. Normally, at the beginning of a pregnancy, the fertilized egg travels from the fallopian tube to the uterus , where it implants and grows. But in a small number of diagnosed pregnancies, the fertilized egg attaches to an area outside of the uterus, which results in an ectopic pregnancy also known as a tubal pregnancy or an extrauterine pregnancy.
An ectopic pregnancy cannot support the life of a fetus for very long. But an ectopic pregnancy can grow large enough to rupture the area it occupies, cause heavy bleeding, and endanger the mother. A woman with signs or symptoms of an ectopic pregnancy requires immediate medical care.
An ectopic pregnancy can develop in different locations. In most ectopic pregnancies, the fertilized egg has implanted in a fallopian tube. Ectopic pregnancy can damage the fallopian tube, which can make it difficult to become pregnant in the future. Ectopic pregnancies are usually detected early enough to prevent deadly complications such as severe bleeding. A ruptured ectopic pregnancy requires emergency surgery to prevent heavy bleeding into the abdomen.
The affected tube is partially or fully removed. For more information, see Surgery. Things that can increase your risk of having an ectopic pregnancy include:. Medical treatments and procedures that can increase your risk of having an ectopic pregnancy include:. Ectopic pregnancy has been linked to the use of medicine used to make the ovary release multiple eggs superovulation. Experts do not yet know whether this is because many women using it already have fallopian tube damage or because of the medicine itself.
If you become pregnant and are at high risk for ectopic pregnancy , you will be closely watched. Doctors do not always agree about which risk factors are serious enough to watch closely.
But research suggests that risk is serious enough if you have had a tubal surgery or an ectopic pregnancy before, had DES exposure before birth, have known fallopian tube problems, or have a pregnancy with an intrauterine device IUD in place.
If you are pregnant, be alert to the symptoms that may mean you have an ectopic pregnancy, especially if you are at risk. If you have symptoms of an ectopic pregnancy or you are being treated for an ectopic pregnancy, avoid strenuous activity until your symptoms have been evaluated by a doctor. Call or other emergency services immediately if:. Call your doctor now or seek immediate medical care if:. Your family doctor , general practitioner , or an emergency medicine specialist can check you for an ectopic pregnancy.
You may be referred to a specialist, such as a gynecologist. Most ectopic pregnancies can be detected using a pelvic examination, ultrasound, and blood tests. If you have symptoms of a possible ectopic pregnancy, you will have:. Sometimes a surgical procedure using laparoscopy is used to look for an ectopic pregnancy. An ectopic pregnancy after 5 weeks can usually be diagnosed and treated with a laparoscope. But laparoscopy is not often used to diagnose a very early ectopic pregnancy, because ultrasound and blood pregnancy tests are very accurate.
During the week after treatment for an ectopic pregnancy, your hCG human chorionic gonadotropin blood levels are tested several times. Your doctor will look for a drop in hCG levels, which is a sign that the pregnancy is ending hCG levels sometimes rise during the first few days of treatment, then drop. In some cases, hCG testing continues for weeks to months until hCG levels drop to a low level. If you become pregnant and are at high risk for an ectopic pregnancy , you will be closely watched.
A urine pregnancy test—including a home pregnancy test—can accurately diagnose a pregnancy but cannot detect whether it is an ectopic pregnancy. If a urine pregnancy test confirms pregnancy and an ectopic pregnancy is suspected, further blood testing or ultrasound is needed to diagnose an ectopic pregnancy. In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. The decision about which treatment to use depends on how early the pregnancy is detected and your overall condition.
For an early ectopic pregnancy that is not causing bleeding, you may have a choice between using medicine or surgery to end the pregnancy. Using methotrexate to end an ectopic pregnancy spares you from an incision and general anesthesia. But it does cause side effects and can take several weeks of hormone blood-level testing to make sure that treatment has worked.
Methotrexate is most likely to work:. If you have an ectopic pregnancy that is causing severe symptoms, bleeding, or high hCG levels, surgery is usually needed. This is because medicine is less likely to work and a rupture becomes more likely as time passes. When possible, laparoscopic surgery that uses a small incision is done. For a ruptured ectopic pregnancy , emergency surgery is needed. For an early ectopic pregnancy that appears to be naturally miscarrying aborting on its own, you may not need treatment.
Your doctor will regularly test your blood to make sure that your pregnancy hormone hCG, or human chorionic gonadotropin levels are dropping. This is called expectant management. Ectopic pregnancies can be resistant to treatment. If your blood type is Rh-negative , Rh immunoglobulin may be used to protect any future pregnancies against Rh sensitization.
For more information, see the topic Rh Sensitization During Pregnancy. Surgery may be your only treatment option if you have internal bleeding. You cannot prevent ectopic pregnancy, but you can prevent serious complications with early diagnosis and treatment.
If you have one or more risk factors for ectopic pregnancy, you and your doctor can closely monitor your first weeks of a pregnancy. If you smoke, quit to lower your risk of ectopic pregnancy. Women who smoke or who used to smoke have higher rates of ectopic pregnancy. Using safer sex practices, such as using a male condom or a female condom every time you have sex helps protect you from sexually transmitted infections STIs that can lead to pelvic inflammatory disease PID.
PID is a common cause of scar tissue in the fallopian tubes, which can cause ectopic pregnancy. If you are at risk for having an ectopic pregnancy and you think you may be pregnant, use a home pregnancy test.
If it is positive, be sure to have a confirmation test done by a doctor, especially if you are concerned about having an ectopic pregnancy. If you are receiving methotrexate treatment to end an ectopic pregnancy, you may experience side effects from the medicine. See these tips for managing methotrexate treatment to minimize these side effects.
If you experience an ectopic pregnancy loss, no matter how early in a pregnancy, expect that you and your partner will need time to grieve. It is also possible to develop depression from the hormonal changes after a pregnancy loss. If you have symptoms of depression that last for more than a couple of weeks, be sure to call your doctor or a psychologist, clinical social worker, or licensed mental health counsellor.
You can contact a support group, read about the experiences of other women, and talk to friends, a counsellor, or a member of the clergy. These things may help you and your family deal with a pregnancy loss. If you have had an ectopic pregnancy, you may worry about your chances of having a healthy or ectopic pregnancy in the future. Your risk factors and any fallopian tube damage you may have will impact your future risk and your ability to become pregnant.
Your doctor can answer your questions based on your risk factors. Medicine can only be used for early ectopic pregnancies that have not ruptured.
Depending on where the ectopic growth is and what type of surgery would otherwise be used, medicine may be less likely than surgical treatment to cause fallopian tube damage.
Medicine is most likely to work when an early ectopic pregnancy is not causing bleeding and:. For an ectopic pregnancy that is more developed, surgery is a safer and more dependable treatment. Methotrexate is used to stop the growth of an early ectopic pregnancy. It can also be used after surgical ectopic treatment to ensure that all ectopic cell growth has stopped. Methotrexate treatment is usually the first choice for ending an early ectopic pregnancy.
If the pregnancy is further along, surgery is safer and more likely than medicine to be effective. Routine follow-up blood tests are needed for days to weeks after the medicine is injected.
Methotrexate can cause unpleasant side effects, such as nausea, indigestion, and diarrhea. For information about how to minimize side effects, see these tips for managing methotrexate treatment. If your ectopic pregnancy is not too far advanced and has not ruptured, methotrexate may be a treatment option for you. Successful methotrexate treatment of an early ectopic pregnancy avoids the risks of surgery, may be less likely to damage the fallopian tube than surgery, and is more likely to preserve your fertility.
If you are not concerned with preserving fertility, surgery for an ectopic pregnancy is faster than methotrexate treatment and will likely cause less bleeding. When possible, surgery is done through a small incision using laparoscopy. This type of surgery usually has a short recovery period. An ectopic pregnancy can be removed from a fallopian tube by using salpingostomy or salpingectomy.
Both salpingostomy and salpingectomy can be done either through a small incision using laparoscopy or through a larger open abdominal incision laparotomy. Laparoscopy takes less time than laparotomy. And the hospital stay is shorter. It often starts and stops, and can be bright or dark red in colour. Some women mistake this bleeding for a regular period and do not realise they are pregnant. Shoulder tip pain — shoulder tip pain is felt where your shoulder ends and your arm begins.
It is not known exactly why shoulder tip pain occurs, but it usually occurs when you are lying down and is a sign that the ectopic pregnancy is causing internal bleeding. The bleeding is thought to irritate the phrenic nerve, which is found in your diaphragm the muscle used during breathing that separates your chest cavity from your abdomen. The irritation to the phrenic nerve causes referred pain pain that is felt elsewhere in the shoulder blade.
Diarrhoea and vomiting — an ectopic pregnancy can cause similar symptoms to a gastrointestinal disease and is often associated with diarrhoea and vomiting. It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions. If an ectopic pregnancy is detected at an early stage, a medication called methotrexate is sometimes needed to stop the egg developing.
The pregnancy tissue is then absorbed into the woman's body. Methotrexate is not always needed, as in around half of cases the egg dies before it can grow larger. Ectopic pregnancies detected at a more advanced stage will require surgery to remove the pregnancy sac. If an ectopic pregnancy is left to develop, there is a risk that the fertilised egg could continue to grow and cause the fallopian tube to split open rupture , which can cause life-threatening internal bleeding.
A ruptured fallopian tube is a medical emergency. If you think that you or someone in your care has experienced this complication, call and ask for an ambulance. In a normal pregnancy an egg is fertilised by sperm in one of the fallopian tubes, which connect the ovaries to the womb. The fertilised egg then moves into the womb and implants itself into the womb lining endometrium , where it grows and develops. An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb.
It most commonly occurs in a fallopian tube this is known as a tubal pregnancy , often as the result of damage to the fallopian tube or the tube not working properly. Less commonly in around 2 in cases , an ectopic pregnancy can occur in an ovary, in the abdominal space or in the cervix neck of the womb.
In many cases, it's not clear why a woman has an ectopic pregnancy. Sometimes it happens when there's a problem with the fallopian tubes, such as them being narrow or blocked. The loss of your pregnancy at any stage can have a huge impact on you and your partner.
One day you are pregnant and planning your future life with your child, and then within a short time, your pregnancy ends. The ending of an ectopic pregnancy is a form of miscarriage — and the feelings that a woman and her partner may experience can be similarly difficult. It is not uncommon for feelings of grief and bereavement to last for 6 to 12 months, although these feelings usually improve with time.
Pregnancy, Birth and Baby offers free and confidential support and counselling to women, their partners, friends and relatives. Call on Many women affected by a miscarriage benefit from counselling.
SANDS miscarriage, stillborn and neonatal death support provide support groups for parents and their family whose baby has died through stillbirth , miscarriage , ectopic pregnancy and medically advised termination. It is normally recommended that you wait for at least 2 menstrual cycles before trying for another pregnancy, as this will allow time for your fallopian tubes to recover if treated with methotrexate, you will need to wait at least 3 to 4 months.
A rupture can be life threatening, but fortunately they're uncommon and treatable, if dealt with quickly. Deaths from ruptures are extremely rare in the UK. You'll be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have. Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant.
Talk to your doctor about this. Read more about treating an ectopic pregnancy. Losing a pregnancy can be devastating, and many women feel the same sense of grief as if they had lost a family member or partner.
It's not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve. If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your GP about this. Read more about dealing with loss and find bereavement support services in your area.
You may want to try for another baby when you and your partner feel physically and emotionally ready. You'll probably be advised to wait until you've had at least 2 periods after treatment before trying again to allow yourself to recover. If you were treated with methotrexate, it's usually recommended that you wait at least 3 months because the medicine could harm your baby if you become pregnant during this time.
Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they've had a fallopian tube removed.
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