The diagnosis of ectopic pregnancy is given when a fertilized egg implants outside the uterus. Most of the time, ectopic pregnancies occur in the fallopian tube, but they can also be found in the ovary, pelvic cavity and cervix. An ectopic pregnancy is never viable and immediate treatment is essential to protect the mother from the possibility of internal bleeding from a burst fallopian tube and preserve future fertility. Ectopic pregnancy is the leading cause of maternal death in the first trimester. Women with a history of pelvic inflammatory disorder (PID), previous ectopic pregnancy, past pelvic surgeries or endometriosis have a higher risk of ectopic pregnancy.
Ectopic pregnancies can be somewhat difficult to diagnose since it is generally early in the pregnancy and a woman may exhibit “normal” pregnancy symptoms until gestation is at a stage where the growth of the fetus puts pressure on the tube. An ectopic pregnancy may include any or all of the following symptoms and warning signs:
• Positive pregnancy test
• Tender breasts
• Spotting or bleeding
• Dizziness or fainting
• Low back pain
• Pelvic pain centered on the right or left side
• Shoulder pain
An early ultrasound will look for the presence of a gestational sac in the uterus to determine whether there is an intrauterine pregnancy (vaginal ultrasounds are quite accurate as long as the pregnancy is far enough along that the sac has developed). The ultrasound may also show whether or not there is fluid in the pelvic cavity, another sign of ectopic pregnancy. A blood panel can ascertain current HCG levels to find out the stage of pregnancy and whether the numbers are doubling each day as they might in the average pregnancy. An ectopic pregnancy may show an unusual pattern of HCG and lower lingering levels. In some cases, dropping numbers may indicate that the ectopic pregnancies will resolve like a natural miscarriage by reabsorbing in the body. Others can continue to pose problems even with low levels of HCG particularly when the numbers are not dropping sufficiently as they might in an average miscarriage.
Lingering HCG numbers and pain indicate a need for immediate treatment. If the ectopic pregnancy is caught early enough, a doctor can administer the drug methotrexate, an anti-folate that stops cellular replication, helping to end the ectopic pregnancy. With methotrexate, HCG levels are tested in regular intervals thereafter to ensure numbers are dropping sufficiently. Depending on the outcome of the initial treatment subsequent injections may be required. Methotrexate is a popular treatment because it can avoid surgeries that are inevitable once the fallopian tube has burst, risking internal bleeding. Another option is reparative surgery to remove the ectopic pregnancy through laparascopic surgery or removing the portion of the tube affected and fusing the remaining parts together. The chance of having subsequent ectopic pregnancy increases about 15% after the first case.