Ectopic pregnancy

An ectopic pregnancy is a pregnancy that instead of implanting into the uterus it implants outside of it. Ectopic pregnancies are usually tubal, but in rare occasions they can be placed in other locations like the ovaries, the cervical canal or the abdomen.

Ectopic pregnancy. Why does it happen?

In a natural cycle, when ovulation occurs the egg is captured by the tubes. If at that moment there is sexual intercourse, the spermatozoons will climb up the vagina through the uterine cavity and the tube in order to find the egg in the distal third where fertilization takes place. After the fertilization the embryo starts developing and gets back through the tube to implant in the uterine cavity some days after. If this process is altered, the embryo could implant outside the womb and produce an ectopic pregnancy.

Who has a higher risk of having an ectopic pregnancy?

One out of 100 spontaneous pregnancies is ectopic. Its incidence is higher when there is any risk of a tube alteration, as in the case of former abdominal surgeries or a previous one, pelvic inflammatory disease, endometriosis… It happens also often in pregnancies achieved by a cycle of in vitro fertilization, probably due to side anatomic alterations to the ovarian stimulation.

What are the symptoms?

Sometimes the ectopic pregnancy is diagnosed at the medical practice when a scan is carried out even if there were no previous symptoms. When there are troubles, the usual symptoms are often vaginal bleeding and pelvic pain. When there is a haemoperitoneum, besides these symptoms there can also be hypotension, faint feeling, shoulder pain… These symptoms can appear in a woman that knows she is pregnant, as well as in a woman that doesn’t know she is pregnant and has mistaken a bleeding caused by the ectopic pregnancy with her menstruation.

How is it diagnosed?

In a scan carried out 5-6 weeks of pregnancy there has to be a gestational sac inside the uterus. Should this not be the case we have to suspect a possible ectopic pregnancy and look for the pregnancy outside the womb. Sometimes we can see clearly the ectopic pregnancy in the scan. If we are not able to see any image in the scan, we will make the diagnosis by a correct clinical assessment using an ultrasound monitoring and by the level of beta-HCG. .

Which is the treatment?

This treatment can be conservative (some ectopic pregnancies end spontaneously producing a tubal abortion), pharmacological (with metotrexate), or with surgery (carrying out a laparoscopy). The treatment will be applied depending on the patient’s symptoms and the results of the scan and the analysis.