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DESCRIPTION
A ectopic 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.
FREQUENT SIGNS & SYMPTOMS
Early signs:
- 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 preceded or accompany pain (sometimes).
CAUSES
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.
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 endometriosis (inflammation of the endometrium [lining of the uterus]).
Malformed (abnormal) uterus.
PREVENTIVE MEASURES
Use a contraceptive method other than an IUD.
Obtain prompt treatment for any pelvic infection.
EXPECTED OUTCOME
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 50-85% of patients.
POSSIBLE COMPLICATIONS
Infection.
Diminished fertility.
Loss of reproductive organs after complicated surgery.
Shock and death from internal bleeding.
TREATMENT
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 (Dilation & 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.
MEDICATION
In some early, unruptured or chronic ectopic pregnancies, methotrexate (a chemotherapy drug) is used as an effective medical approach in removing the pregnancy tissue. Specific guidelines and close 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.
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.
DIET
No special diet. However a well-balanced diet will help build a strong immune system and aid in the healing process after surgery is performed.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of ectopic pregnancy, especially a rupture. Call for emergency medical care immediately. This is an emergency and can be life-threatening!
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.
- Increases urinary frequency that lasts longer than 1 month. this may be a sign of bladder infection or infection resulting from surgery.
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