Ectopic pregnancy: Rare, but can be serious

Patients receiving fertility treatment are at higher risk

According to Dr. Tarek Khalife, a Mayo Clinic Health System OB-GYN physician, ectopic pregnancies are rare. However, he says in the off chance an ectopic pregnancy is discovered, it’s a situation that must be taken seriously. Often, patients have questions and are looking for answers to understand this condition.

“Ectopic pregnancy occurs when a fertilized egg attaches itself outside of the uterus,” says Khalife. “Ninety percent of the time, it attaches to the fallopian tube. However, in other instances, it can attach to the ovary, cesarean section scar, cervix or even the abdomen. If attached to the abdomen, the danger of complications is significantly increased.”

It’s rare for an ectopic pregnancy to coexist with another normal intrauterine pregnancy; yet, it’s still possible, and poses critical challenges in diagnosis and treatment. Luckily, it’s an uncommon event, except in patients receiving fertility treatments, where the prevalence is a ratio of 1 in 100, compared to 1 in 30,000 in spontaneous pregnancies.

Ectopic pregnancies don’t have specific symptoms and can be easily missed if the health care provider fails to keep it in mind. Ectopic pregnancyrelated symptoms vary between showing no symptoms at all, especially during the early stages, to severe lower abdominal pain with dizziness caused by massive internal bleeding.

Presentation and symptoms also vary depending on the location of the ectopic implantation. Khalife says commonly reported symptoms of ectopic pregnancies include vaginal spotting and vague lower abdominal or pelvic pain.

However, vaginal spotting and vague lower abdominal or pelvic pain can mimic the same symptoms as patients with normal pregnancies.

“This is why it’s important to track your periods,” explains Khalife. “When you miss your period, especially if you’re not on reliable birth control, you should perform a pregnancy test and follow up with your health care provider as soon as possible. This helps you document a potential pregnancy’s location and viability at around five to six weeks of gestation, and increases the chance of early diagnosis and treatment of an ectopic pregnancy.

“Make sure to visit your health care provider even sooner if you experience abnormal bleeding or pain with a positive pregnancy test, as this could be the early signs of an impending rupture.”

Ectopic pregnancy diagnosis

“Ectopic pregnancy is diagnosed when the gestational sac with a live fetal pole or yolk sac is found outside an empty uterine cavity,” says Khalife. “Sometimes, diagnosis can be challenging if the ectopic pregnancy is in its early stage and the sac is not yet visible by ultrasound.”

In these scenarios, Khalife says pregnancy hormone levels are monitored for the rate of rise, which tends to be abnormal in cases of pregnancy in ectopic implantations. Rarely, when pregnancy hormones are not rising normally and the location of the ectopic pregnancy is not confidently identified despite serial follow-up ultrasounds and pregnancy hormone testing, aspiration of the uterine cavity is performed to rule out an abnormal uterine pregnancy.

Treatment options

Treatment of ectopic pregnancy depends on the gestational age, symptoms and location of the gestational sac. Advanced ectopic pregnancy usually presents with rupture, pain or severe bleeding. In these situations, surgical treatments often are indicated for removal of the pregnancy and control of bleeding to protect the mother.

If ectopic pregnancy is diagnosed early and before the onset of symptoms, a medication can be used to stop the growth of the pregnancy and allow the body to absorb it without removing the fallopian tubes.

In the case of a tubal pregnancy, surgical treatments include laparoscopic surgery to remove the ectopic tissue and repair the fallopian tube.

“The condition of the fallopian tube and degree of damage by the ectopic pregnancy usually determines the recommended approach,” says Khalife.