Tubal Pregnancy (Ectopic Pregnancy)

A tubal, or ectopic, pregnancy occurs when a fertilized egg becomes implanted in one of the fallopian tubes (or less commonly, elsewhere in the pelvic cavity) rather than in the uterus. Normally, an egg enters a fallopian tube after it is released from an ovary during ovulation. When conception takes place, it usually does so within the tube and the fertilized egg then proceeds to the uterus. If all goes well, pregnancy is established. In about 1 in 80 pregnancies in the United States, however, something goes wrong; the fertilized egg fails to reach the uterus and develops instead in the tube.

A tubal pregnancy is always a medical emergency and should be regarded as such. In fact, it is the leading cause of maternal death during the first trimester. As the embryo grows, it stretches the fallopian tube. When untreated, it can result in a rupture of the tube and sudden, massive bleeding.

The first signs of a tubal pregnancy may occur before a woman even knows she is pregnant. Soon after the first menstrual period is missed, spotting and abdominal cramping begin. If the tube ruptures, there is sudden sharp and intense abdominal pain. Severe bleeding can cause a drop in blood pressure, dizziness, or faulting. The woman also may go into shock; its symptoms include paleness, a rapid heartbeat, low blood pressure, and cold, clammy skin.

The frequency of tubal pregnancy varies greatly from country to country. In Jamaica, for example, the incidence is 1 for every 28 normal births. The rate in the United States has increased fourfold since the 1960s, paralleling the rise in pelvic inflammatory disease (PID), an infection of the female reproductive organs. PID often scars and damages the fallopian tubes, preventing the normal passage of eggs to the uterus. Other factors increasing the likelihood of a tubal pregnancy include use of an IUD (or, less commonly, a progestin-only oral contraceptive), multiple abortions, and a chromosomal abnormality in the embryo. Women whose mothers took DES, an artificial estrogen, during pregnancy have an increased risk of tubal pregnancy. A faulty tubal ligation can also result in tubal pregnancy.

Diagnostic Studies and Procedures

In some cases, an ectopic pregnancy can be diagnosed on the basis of the symptoms and a physical examination. More often, however, a number of tests are needed, starting with a positive pregnancy test and pelvic examination.

A blood test will be ordered to measure levels of hCG -- a hormone that rises markedly early in a normal pregnancy. A lower than normal rise in hCG calls for further investigation using ultrasound to examine the uterus; if it appears empty, an ectopic pregnancy is highly likely. In such situations, a procedure called culdocentesis may be performed. This involves obtaining fluid from the pelvic cavity in order to determine whether abnormal bleeding is taking place. If doubt still remains, laparoscope the insertion of a viewing lube into the abdominal cavity through a small incision, will be ordered. The procedure, performed using general anesthesia, allows a doctor to examine the fallopian tubes, the uterus, and other pelvic organs.

Medical Treatments

Treatment depends upon the stage and location of the pregnancy. If the tube has ruptured, immediate surgery is essential to save the woman's life. In such cases, blood transfusions may be needed.

Sometimes, an ectopic pregnancy degenerates on its own, precluding the need for any treatment. In other cases, methotrexate -- a drug normally used to treat cancer, severe arthritis, and psoriasis -- is given to halt growth of the embryo, which is then gradually reabsorbed by the body. In such situations, a woman will remain in the hospital for a few days of careful monitoring to make sure that a crisis does not develop.

When medication does not work or a ruptured tube is likely, an operation must be performed to remove the developing embryo. If the problem is caught early enough, the doctor may be able to spare the tube. In more advanced cases, however, removal of part or all of the tube is usually necessary. If the remaining tube is normal, a future pregnancy is possible. Or if enough of the tube remains and a future pregnancy is desired, reconstructive surgery can be tried. In either instance, there is a high risk of another ectopic pregnancy. In vitro fertilization is a possible alternative when pregnancy cannot be achieved naturally.

Alternative Therapies

No alternative therapy is effective in treating a tubal pregnancy.

Self-Treatment

While resting in bed following surgery, move your legs often to prevent blood clots from forming. Your doctor may recommend specific leg exercises and also instruct you to wear surgical elastic stockings to improve blood flow.

After leaving the hospital, resume normal daily activities as soon as possible but avoid becoming overly fatigued. This helps to prevent postoperative depression. However, do not attempt vigorous exercise, heavy lifting, and straining for about six weeks or until your doctor approves such activities.

Other Causes of Pelvic Symptoms

A threatened or incomplete miscarriage can produce symptoms similar to those of a tubal pregnancy; so too can a ruptured ovarian cyst, PID, and acute appendicitis. Some pain, bleeding, and other symptoms might be due to a normal pregnancy.