| Basic Information |
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| Description |
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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.
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| Frequent Signs and Symptoms |
Early stages:
- Missed menstrual period or any menstrual irregularity.
- 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).
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| Causes |
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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.
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| Risk Increases With |
- Use of an intrauterine device (IUD) for contraception that results in a pelvic infection.
- Previous abdominal or pelvic infection (e.g., ruptured appendicitis).
- Adhesions (bands of scar tissue) from previous abdominal surgery.
- Previous tubal pregnancy.
- Previous tubal or uterine surgery.
- History of endometritis (inflammation of the endometrium [lining of the uterus]).
- Malformed (abnormal) uterus.
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| Preventive Measure |
- Use a contraceptive method other than IUD.
- Obtain prompt treatment for any pelvic infection.
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| Expected Outcome |
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An ectopic pregnancy cannot progress to full term or produce a
viable fetus. Rupture of an ectopic pregnancy is an emergency
requiring immediate treatment. Full recovery is likely with
early diagnosis and surgery. Subsequent pregnancies are normal
in about 50 to 85% of patients.
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| Possible Complications |
- Infection.
- Diminished fertility.
- Loss of reproductive organs after complicated surgery.
- Shock and death from internal bleeding.
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| Treatment/Post Procedure Care |
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| General Measures |
- Diagnostic tests may include serum pregnancy test,
ultrasound, culdocentesis (a needle is inserted through the
back of the vagina and pelvic fluid is aspirated), laparoscopy
(telescope instrument with fiber optic light is inserted into
the abdomen for visual examination and may be used to remove
the ectopic pregnancy), D & C (dilatation and curettage) and
exploratory laparotomy.
- Evaluation and treatment may be done on an outpatient basis.
- Hospitalization may be required for surgery and supportive care.
Blood transfusion may be necessary.
- Surgery to remove the developing embryo, 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.
Following surgery:
- After 24 hours, 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.
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| Medication |
- In some early, unruptured or chronic ectopic pregnancies,
methotrexate (a chemotherapy drug) is effective in removing the
pregnancy tissue. Specific guidelines and dose follow-up are
necessary when this drug is prescribed
- After operative procedures, pain relievers such as
nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics
may be prescribed for 2 to 7 days.
- Antibiotics if infection is present.
- Iron supplements if necessary for anemia.
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| Activity |
- Resume your normal activities including work as soon as
possible following the treatment procedure utilized. Recovery is
generally faster with laparoscopy than with laparotomy.
- Avoid sexual relations until a follow-up medical examination
determines healing is complete.
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| Diet |
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No special diet.
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| Notify Your Healthcare Provider If |
- You or a family member has symptoms of ectopic pregnancy,
especially a rupture. Call immediately. This is an emergency!
- The following occur 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.
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