Baby growing in fallopian tube symptoms
Ectopic (Extrauterine) Pregnancy
Series Ectopic Pregnancy
Written by Shishira Sreenivas
What Is Ectopic Pregnancy?
Usually, a fertilized egg attaches itself to the lining in your uterus. But with an ectopic pregnancy (also called extrauterine pregnancy), the fertilized egg grows outside your uterus. This can include other areas like a fallopian tube, the ovaries, in your belly, or the lower part of your cervix, which is above the vagina. In more than 90% of cases, the egg attaches itself in a fallopian tube. This is called a tubal pregnancy.
Rates are hard to determine, but one study suggests that about 1 in 50 pregnancies in the U.S. are ectopic. As the fertilized egg grows, it can burst (rupture) and can cause life-threatening bleeding. If this happens, you will need medical care right away. If you don’t treat it, it can be deadly. In fact, ectopic pregnancies are the leading cause of pregnancy-related deaths in the first trimester.
It’s important to note that the fertilized egg in an ectopic pregnancy is not “viable. ” That means it’s impossible for the egg to survive and grow into a baby that can survive in or outside your body. It will always result in a pregnancy loss. That’s because the egg can’t get the blood supply and support it needs to grow outside of the uterus.
Ectopic Pregnancy Signs and Symptoms
Most of the time, an ectopic pregnancy happens within the first few weeks of pregnancy. You might not even know that you're pregnant and may not notice any problems.
Early signs of an ectopic pregnancy include:
- Light vaginal bleeding and pelvic pain
- Upset stomach and vomiting
- Sharp abdominal cramps
- Pain on one side of your body
- Dizziness or weakness
- Pain in your shoulder, neck, or rectum
An ectopic pregnancy can cause your fallopian tube to burst or rupture. Emergency symptoms include major pain, with or without severe bleeding. Call your doctor right away if you have heavy vaginal bleeding with lightheadedness, fainting, or shoulder pain, or if you have severe belly pain, especially on one side.
You might need to call 911 or head to the nearest hospital to have it treated right away.
Ectopic Pregnancy Causes and Risk Factors
You may never know why you have an ectopic pregnancy. One cause could be a damaged fallopian tube. It could keep the fertilized egg from getting into your uterus.
You’re more likely to have an ectopic pregnancy if you:
- Have pelvic inflammatory disease (PID)
- Smoke cigarettes
- Are older than 35
- Have a sexually transmitted infection
- Have scarring from pelvic surgery
- Had a previous ectopic pregnancy
- Tried to have tubal ligation (tubes tied) or tubal ligation reversal
- Use fertility drugs
- Had fertility treatments such as in vitro fertilization (IVF)
It could also happen if you become pregnant while you have an intrauterine device (IUD) for birth control.
Ectopic Pregnancy Complications
During an ectopic pregnancy, the fertilized egg is wrapped in a structure that can grow for several weeks outside your uterus.
But the structure usually bursts between 6 and 16 weeks. This can cause severe bleeding. If the bleeding isn’t stopped, your body might start to shut down due to the blood loss (hemorrhagic shock), and the odds of dying from it increases. If it’s treated before it bursts, it rarely results in death.
If the structure does burst, it may damage the fallopian tube it was attached to. Your doctor might remove the fallopian tube during the surgery. But you have two fallopian tubes. If your other fallopian tube is healthy, you should still be able to get pregnant. But if your other fallopian tube is damaged or not there, you may have fertility issues. In this case, talk to your doctor about other ways to get pregnant, like IVF (in vitro fertilization).
Ectopic Pregnancy Diagnosis
Your doctor will probably do tests that include a pregnancy test and a pelvic exam. They might give you an ultrasound to look at your uterus and fallopian tubes.
Ectopic Pregnancy Treatment
Because a fertilized egg can’t survive outside a uterus, your doctor will need to take it out, so you don’t have serious health problems.
They’ll use one of two methods: medication or surgery.
Medication. If your fallopian tube hasn’t ruptured and your pregnancy isn’t far along, your doctor can give you a shot of methotrexate (Trexall). You only need one dose of the injection. It stops the fertilized egg from growing. Your body will absorb the egg in about 4-6 weeks. With this treatment, there’s no need to remove the fallopian tube.
Before you can take methotrexate, your doctor will need to run a few blood tests to measure your hCG levels (human chorionic gonadotropin). It’s the hormone your body produces when it detects a pregnancy. You won’t be able to take methotrexate if you’re breastfeeding or have certain health problems.
Once you get the shot, the doctor will check your hCG levels during follow-up appointments. If your levels don’t drop after the first dose, you might need a second dose of the same medication. You’ll need to follow up until your blood no longer has hCG.
It’s important to note that taking methotrexate is not the same as having a medical abortion, as you could get if you had a “viable” pregnancy in which the fertilized egg attaches inside the uterus.
For a medical abortion, you need a combination of two prescription drugs: mifepristone and misoprostol.
The methotrexate that you take during an ectopic pregnancy before the egg bursts is medically necessary. It can lower your risk of dying or other serious complications.
Surgery. In other cases, you’ll need surgery. The most common is laparoscopy. Your doctor will make very small cuts in your lower belly and insert a thin, flexible tube called a laparoscope to remove the ectopic pregnancy. If your fallopian tube is damaged, they may have to remove it as well. If you’re bleeding a lot or your doctor suspects that your fallopian tube is ruptured, you might need emergency surgery with a larger cut. This is called a laparotomy.
Surgery side effects can include:
- Pain
- Fatigue
- Bleeding
- Infection
Whether you take methotrexate or have surgery, you may feel tired for a few weeks and have some discomfort in your belly.
You may continue to have pregnancy-like symptoms for a bit. It might take a few period cycles before you feel back to normal.
After an Ectopic Pregnancy
It might be hard for you to have a typical pregnancy afterward. Consider talking to a fertility specialist, especially if you had a fallopian tube removed.
And talk to your doctor about how long to wait before trying again. Some experts suggest giving yourself at least 3 months so your body has time to heal.
An ectopic pregnancy raises your risk of having another one. If you think you’re having another pregnancy, be mindful of the changes in your body. Check with your doctor, and they can confirm it and take the necessary steps.
An ectopic pregnancy can take a toll on your mental health, too. Don’t hesitate to reach out to mental health experts like a licensed counselor or therapist.
There’s no way to prevent an ectopic pregnancy. But you can lower your odds with certain lifestyle choices.
You can:
- Use a condom when you have sex.
This can lower your risk for PID and other sexually transmitted infections (STIs) - Quit smoking.
- Avoid using a vaginal douche. Studies show that using a douche can increase the risk of ectopic pregnancy.
Next In Ectopic Pregnancy Series:
SymptomsEctopic Pregnancy (for Parents) - Nemours KidsHealth
What Is an Ectopic Pregnancy?
In a normal pregnancy, the fertilized egg implants and develops in the uterus. In an ectopic pregnancy, the egg implants somewhere other than the uterus — often, in the fallopian tubes. This is why ectopic pregnancies are commonly called "tubal pregnancies." The egg also can implant in the ovary, abdomen, or the cervix.
None of these areas has the right space or nurturing tissue for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth.
What Are the Signs & Symptoms of an Ectopic Pregnancy?
Ectopic pregnancy can be hard to diagnose because symptoms often are like those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, tiredness, or frequent urination (peeing).
Often, the first warning signs of an ectopic pregnancy are pain or vaginal bleeding. There might be pain in the pelvis, abdomen, or even the shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). The pain can range from mild and dull to severe and sharp. It might be felt on just one side of the pelvis or all over.
These symptoms also might happen with an ectopic pregnancy:
- vaginal spotting
- dizziness or fainting (caused by blood loss)
- low blood pressure (also caused by blood loss)
- lower back pain
What Causes an Ectopic Pregnancy?
An ectopic pregnancy usually happens because a fertilized egg couldn’t quickly move down the fallopian tube into the uterus.
The tube can get blocked from an infection or inflammation. The tube can get blocked from:
- pelvic inflammatory disease (PID)
- endometriosis, when cells from the lining of the uterus implant and grow elsewhere in the body
- scar tissue from previous abdominal or fallopian surgeries
- rarely, birth defects that changed the shape of the tube
How Is an Ectopic Pregnancy Diagnosed?
If a woman might have an ectopic pregnancy, her doctor may do an ultrasound to see where the developing fetus is. Often, pregnancies are too small to see on ultrasound until more than 5 or 6 weeks after a woman’s last menstrual period. If an external ultrasound can’t show the pregnancy, the doctor might do the test with a wand-like device in the vagina.
A woman might need testing every few days if the first tests can’t confirm or rule out an ectopic pregnancy.
How Is an Ectopic Pregnancy Treated?
How doctors treat an ectopic pregnancy depends on things like the size and location of the pregnancy.
Sometimes they can treat an early ectopic pregnancy with an injection of methotrexate, which stops the growth of the embryo. The tissue usually is then absorbed by the woman’s body.
If the pregnancy is farther along, doctors usually need to do surgery to remove the abnormal pregnancy.
Whatever treatment she gets, a woman will see her doctor regularly afterward to make sure her pregnancy hormone levels return to zero. This may take several weeks. An elevated level could mean that some ectopic tissue was missed. If so, she might need more methotrexate or surgery.
What About Future Pregnancies?
Most women who have had an ectopic pregnancy can have normal pregnancies in the future. Having had one ectopic pregnancy does increase a woman’s risk of having another one.
What Else Should I Know?
Any woman can have an ectopic pregnancy. But the risk is higher for women who are older than 35 and those who have had:
- PID
- a previous ectopic pregnancy
- surgery on a fallopian tube
- infertility problems or medicine to stimulate ovulation
Some birth control methods also can affect a woman's risk of ectopic pregnancy.
Those who become pregnant while using an intrauterine device (IUD) might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also increase the risk of an ectopic pregnancy.
When Should I Call the Doctor?
If you believe you're at risk for an ectopic pregnancy, meet with your doctor to talk about your options before you become pregnant. If you are pregnant and have any concerns about the pregnancy being ectopic, talk to your doctor — it's important to find it early. Your doctor might want to check your hormone levels or schedule an early ultrasound to ensure that your pregnancy is developing normally.
Call your doctor right away if you're pregnant and having any pain, bleeding, or other symptoms of ectopic pregnancy.
Ectopic pregnancy - Family clinic
24 July 2016 Gynecology
This is the settling and development of the fetal egg outside the uterus. It poses a great danger to the life of a pregnant woman.
A fertilized egg can graft on the ovaries, peritoneum, omentum and other abdominal organs, but most often in the tubes (99%).
Causes of ectopic pregnancy
Unfortunately, this pathology is quite common. During the operation, the couple had to take the fetal egg from anywhere: from the fallopian tubes, ovaries, even from the abdominal cavity. But more often than others, there is still a tubal pregnancy. Why does the attachment of a fertilized egg occur outside the uterus? What makes it go astray and begin to develop in an unintended place? As a rule, the fallopian tubes are to blame, unable to perform their functions.
Clinical experience shows that ectopic pregnancy is almost always preceded by inflammatory or infectious diseases of the genitals, abortion, difficult childbirth, complicated by the inflammatory process. In this case, the mucous membrane of the fallopian tubes swells, its folds stick together, the tubes are deformed and lose their ability to contract normally.
Infantilism also predisposes to ectopic pregnancy.
With this disease, the tubes are excessively elongated, tortuous, their lumen is narrowed, they contract weakly. A healthy tube must contract actively in order to move the egg into the uterus. Moreover, this must be done within strictly defined deadlines, otherwise delay is fraught with disaster. After all, a fertilized egg develops and at a certain stage, villi appear in it, which need to gain a foothold and begin to receive a stable blood supply. If by this time the fetal egg has not been delivered to the uterus, it attaches anywhere, to the wall of the fallopian tube, for example, and begins to grow, unaware that this is the most inappropriate place for the development of the fetus.
After all, the lumen of the pipe is in its different sections from 1 mm to 1.5 cm, and a thin and delicate machine is not capable of stretching like a uterus. Therefore, approximately on the 4th-6th week, the chorionic villi “gnaw through” the wall, the tube breaks - and bleeding occurs into the abdominal cavity, accompanied by a sharp cramping pain in the lower abdomen, a feeling of lightheadedness, dizziness, and often loss of consciousness.
If a large vessel is damaged, massive blood loss threatens the woman with death, and only an emergency operation can save her. Sometimes events develop according to a slightly modified "scenario". It is not the tube that breaks, but the wall of the fetal egg, which is then expelled into the abdominal cavity. There is a so-called tubal abortion, also accompanied by severe pain in the lower abdomen, sometimes vomiting and dark brown bloody discharge from the vagina. After a while, the pain subsides and the woman begins to reassure herself that everything will be fine. No, it won't! And in this case, surgical intervention is necessary, otherwise peritonitis, a purulent inflammation of the peritoneum, may develop.
Diagnosis of ectopic pregnancy
Are there any special signs by which a woman herself can guess about an ectopic pregnancy? Alas, there are no special signs. A catastrophe (ruptures, bleeding) sometimes comes like a bolt from the blue: almost nothing bothers, except for a slight aching pain in the lower abdomen and spotting .
..
And suddenly! But more often, an ectopic pregnancy is disguised as a normal one: the same delay in menstruation, the mammary glands are also engorged, sometimes there is slight nausea, taste and olfactory sensations are distorted. Therefore, a woman cannot independently recognize an ectopic pregnancy, but she certainly can prevent trouble without bringing the matter to bleeding, pain, loss of consciousness. How?
Yes, you just need to go to the antenatal clinic on the 4-7th day after the delay in menstruation. And there the experts will determine what it is connected with. Modern diagnostic methods, including ultrasound, allow you to establish pregnancy in the early stages. It is especially desirable to undergo an ultrasound examination for those who have a delay in menstruation accompanied by spotting bloody discharge.
If you don’t feel like going to the clinic, buy any test indicator for early diagnosis of pregnancy at the pharmacy.
There are a lot of them, and it’s easy to use them (the instructions indicate how). With the help of the indicator, you can make sure that the pregnancy has occurred, but only a specialist can determine what kind of pregnancy it is - normal or pathological. At the slightest suspicion of an ectopic pregnancy, the doctor suggests that the woman go to the hospital.
Do not refuse: only in a specialized institution equipped with modern equipment, you can conduct the necessary studies and make an accurate diagnosis, determine where the embryo was implanted - in the uterus or outside it. Please note: the sooner an ectopic pregnancy is diagnosed, the more gentle ways doctors will be able to terminate it.
If the pathology is detected when the receptacle of the fetal egg is still intact, a laparoscopic, low-traumatic method is used. The surgeon inserts the instrument through a small incision in the skin; he sees the operating field and the manipulations themselves on the monitor (the laparoscope is equipped with an optical system).
With such an intervention, the surrounding organs and tissues are practically not injured, there is no severe bleeding, the risk of adhesions and scarring is much less. Deaths are rare.
Sometimes, with the help of a laparoscope, it is possible to simply "suck" the fetal egg in much the same way as a mini-abortion is done. It is important that during such operations the tube is preserved, it continues to function, and after a while the woman, after undergoing a course of treatment, can become pregnant again.
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Ectopic pregnancy - early signs, first manifestations
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Signs of an ectopic pregnancy. How not to miss the pathology
August 06, 2019
Ectopic or ectopic pregnancy is an atypical course of pregnancy in which implantation and development of the fetal egg occur outside the uterus, for example, in the abdominal cavity, ovary, cervix, fallopian tube.
According to the latest statistics, ectopic pregnancy accounts for approximately 2% of all pregnancies.
At the same time, tubal ectopic pregnancy is most often diagnosed.
Ectopic pregnancy threatens with serious complications - rupture of the fetal egg and peritonitis, recurrence of ectopic pregnancy, infertility. Often it is a threat to a woman's life and, as statistics show, in 3% of all cases it ends in death. Therefore, it is very important to be able to recognize the first signs of an ectopic pregnancy in time.
Further in the article, we will analyze in detail at what time an ectopic pregnancy can manifest itself, its signs in early and late terms, as well as on ultrasound.
How an ectopic pregnancy manifests itself: the first signs
Given all of the above, it is very important to know how an ectopic pregnancy manifests itself. Timely diagnosis of this pathology will help to avoid complications, and in some cases even save the life of a woman.
In the early stages, women can often ignore unusual symptoms and believe that this is how a normal pregnancy should proceed.
Indeed, as the ovum develops, even with an ectopic pregnancy, a woman may experience signs of a normal pregnancy, namely:
- No menses
- Increase in basal body temperature
- Breast engorgement
- Nausea, vomiting
However, along with these symptoms, the first signs of an ectopic pregnancy appear, which should alert. So how does an ectopic pregnancy manifest itself?
The following symptoms may indicate an atypical pregnancy:
- Unpleasant sensations in the lower abdomen, aching, pulling pains in the location of the fetal egg, or in the lower abdomen, mainly on one side - the very first signs of an ectopic pregnancy. Pain may increase during urination or defecation.
- Scanty bloody, spotting discharge that usually lasts a long time. In rare cases, uterine bleeding, or profuse spotting, resembling menstruation, is observed.
- With severe blood loss in the early stages, signs of shock may occur, namely, pale skin, tachycardia, drop in blood pressure, loss of consciousness.
How long can an ectopic pregnancy appear
The timing when the first signs of an ectopic pregnancy appear is individual in each case. In some women, an ectopic pregnancy can be asymptomatic right up to the development of complications, while in others, adverse symptoms can be noticed already from the first weeks of pregnancy.
Usually, the first signs appear with an increase in the size of the fetal egg. Therefore, at what time an ectopic pregnancy appears can be established using ultrasound. Usually, a fetal egg is visualized at a period of 4.5-5 weeks of pregnancy.
The average time for an ectopic pregnancy to appear is 3 to 8 weeks. It is during this period that the highest risk of adverse symptoms!
What are the signs of an ectopic pregnancy at a later date
If you ignore the first signs of an ectopic pregnancy, the risk of complications increases significantly. An ectopic pregnancy can have two outcomes - abortion, or rupture of the fallopian tube, or another organ in which the fetal egg has attached.
In the first case, with an ectopic pregnancy, the signs include intense pain, pain in the posterior vaginal fornix, and bleeding. With intense bleeding, symptoms of shock may appear - a decrease in blood pressure, tachycardia, a weak rapid pulse, shallow breathing, weakness, loss of consciousness.
Signs in case of rupture of the fallopian tube resemble those of ovarian apoplexy. Life-threatening internal bleeding develops, acute, dagger pain in the lower abdomen occurs, which can radiate to the perineum and anus, symptoms of shock are expressed. This condition requires immediate hospitalization!
Signs of ectopic pregnancy on ultrasound
With such a pathology as an ectopic pregnancy, ultrasound signs can be determined at about 4.5-5 weeks of pregnancy. Usually, ultrasound does not allow to detect a fetal egg outside the uterus, so they are guided by other signs.
Ectopic pregnancy findings on ultrasound include the following:
- Absence of a fertilized egg in the uterus
- The presence of an inhomogeneous mass in the area of the appendages on one side
- Abdominal fluid
Only ultrasound can confirm the diagnosis of abnormal pregnancy.
