Ectopic pregnancy

Alternative names:

abdominal pregnancy; cervical pregnancy; tubal pregnancy

Treatment:

In the event that pelvic-organ rupture has occurred because of the ectopic pregnancy, internal bleeding and/or hemorrhage may lead to shock. Nearly 20% of ectopic pregnancies present themselves in this manner. This is an emergency condition. Therefore, initial treatment may be to address shock by keeping the woman warm, elevating her legs, and administering oxygen. A blood transfusion is performed as soon as possible.

Surgical laparotomy is performed to stop the immediate loss of blood (in cases in which rupture has already occurred), or to confirm the diagnosis of ectopic pregnancy, remove the products of conception, and repair surrounding tissue damage as much as possible. In nonemergency cases, mini-laparotomy or laparoscopy may be alternative surgical methods. Such alternatives have similar outcomes, however, they are less invasive and are available at a lower cost because they require minimal hospitalization or outpatient treatment.

Nonsurgical (medical) management is being implemented in some medical centers for very early ectopic pregnancies without suspected immediate danger of rupture. In such cases, methotrexate is administered with careful outpatient monitoring of the woman and serial quantitative HCGs and CBCs.

Expectations (prognosis):

About 50% of the women who have experienced an ectopic pregnancy are later able to achieve a normal pregnancy. A subsequent ectopic pregnancy may occur in 10 to 20 % of cases. Some women fail to become pregnant again, while others become pregnant and spontaneously abort during the first trimester. The maternal death rate from ectopic pregnancy in the U.S. is 1 to 2%. Fetal death rate is nearly 100%.

Complications:

• Rupture, with resulting hemorrhage leading to shock and possible death, is the most common complication.
• Infertility occurs in nearly 50% of women who have experienced an ectopic pregnancy with surgical treatment.

Calling your health care provider:

Call for an appointment with your health care provider if symptoms occur in a woman who has the opportunity to become pregnant. Ectopic pregnancy can occur in any woman who is sexually active, regardless of contraceptive use.