What is an Ectopic Pregnancy and What are the Risk Factors?
An ectopic pregnancy is one that occurs in the fallopian tube, instead of in the uterus. As the pregnancy grows the fallopian tube can rupture, leading to catastrophic internal bleeding and even death, so it is very important to make this diagnosis. It often presents with irregular vaginal bleeding in pregnancy and abdominal/shoulder pain.
Risk factors include a history of pelvic inflammatory disease, chlamydia, current IUD use and prior abdominal surgery. The biggest risk factor is prior ectopic pregnancy.
How do you treat it?
Early, stable ectopic pregnancies in appropriate hemodynamically stable patients can be treated with an IM injection of methotrexate.
Those who are not stable, who are very large or where there is a fetal heartbeat in the fallopian tube or the pregnancy hormone levels are high or the mass is large or the patient is bleeding into her abdomen or the patient is not stable will require surgery.
If the patient is stable this is most often accomplished by laparoscopy. Often times the fallopian tube needs to be removed, but in some cases the ectopic can be removed without removing the tube. There is a much higher risk, however, of repeat ectopic if the damaged tube is left behind.
What is the risk it will happen again?
There is about a 10% chance that after one ectopic that the next pregnancy will be ectopic. We have a high suspicion in future pregnancies, and since this is a dangerous condition, as soon as a period is missed the patient should be instructed to come in and call and we draw blood right away to check HCG and progesterone levels and follow them every 2 days to make sure they are rising appropriately until we can see a pregnancy in the uterus on pelvic sonogram.
Patients are also given explicit ectopic precautions and know to call with any abdominal or shoulder pain or irregular vaginal bleeding.
Have questions about ectopic pregnancy?
Schedule an appointment to chat with us at 516-365-6100. We answer questions like this every day and would love to meet you! We're conveniently located off the Northern State Parkway on New Hyde Park Road just minutes from North Shore University Hopital and Northwell Health.
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