What is an Ectopic Pregnancy?
An ectopic pregnancy is a pregnancy that has implanted outside the normal location in the cavity of the uterus. The vast majority of these pregnancies implant in one of the fallopian tubes that reach out from the uterus towards the ovaries. These “tubal” ectopic pregnancies occur because the fertilized egg gets stuck on its way down the tube from the ovary to the uterus. The problem with tubal pregnancies is that they cannot survive in this location, nor can they be moved into the uterus. Eventually they can rupture through the wall of the tube and lead to serious, life threatening internal bleeding. Therefore, patients with an ectopic pregnancy need to be treated as soon as the diagnosis is made. Other possible locations for ectopic pregnancies include the cervix, ovaries, pelvic cavity or the corner of the uterus where the tube is attached.
Symptoms of an Ectopic Pregnancy
Patients who have had a previous ectopic pregnancy are at an increased risk of having another one, as are patients who have infertility or who have had a previous sexually transmitted disease such as Chlamydia, pelvic inflammatory disease, previous abdominal, pelvic or tubal surgery, prior appendicitis, or who are using contraception when they conceive. The most common symptoms of an ectopic pregnancy are abnormal vaginal bleeding and pelvic pain especially if it is stronger on one side more than the other. Many patients with early ectopic pregnancies will have no symptoms.
Ectopic Pregnancy Treatment Options
The surgical option usually involves doing a laparoscopy to visualize the fallopian tubes, and if an ectopic pregnancy is seen, to either remove the ectopic from the tube (salpingostomy) or remove the tube itself (salpingectomy). Whether to remove just the ectopic pregnancy or the entire tube with the ectopic in it, depends on your particular case, and will be discussed with you. Often tissue from the uterine cavity is removed as well (D&C). Rarely, an abdominal incision is necessary to properly perform the surgery, as in the case of excessive bleeding or excessive internal scar tissue.
The medical option involves a drug called methotrexate, which is given as a shot to dissolve the pregnancy tissue. Methotrexate stops the growth of cells which are dividing rapidly such as pregnancy cells. It is also used in much higher doses for the treatment of some cancers or for rheumatoid arthritis. It is generally quite safe when given in the low dose used for ectopic pregnancies and the majority of the time will allow the patient to avoid surgery. Some patients with liver, kidney or other significant medical problems may not be candidates for methotrexate. It is still possible for an ectopic pregnancy to rupture after a methotrexate shot, so patients need to report any symptoms of significant pain right away. Depending on how high the hCG levels are before treatment it may take several weeks for the levels to drop all the way to zero, which is when we know the treatment has been successful. After the shot has been given, frequent blood tests are necessary to assure optimal treatment. In some cases a second or rarely third shot may be necessary.
Overall, the chances of having successful future pregnancies are about equal with laparoscopic removal of the ectopic, removal of the tube or methotrexate therapy. A discussion with your health care provider about all of these issues will help you decide on the best treatment for you.