Signs and Symptoms of Tubal Pregnancy

Tubal Pregnancy

A tubal pregnancy, also called an ectopic pregnancy, happens when a fertilized egg implants in a fallopian tube instead of in the uterus. The fallopian tubes connect the ovaries to the uterus. When a woman ovulates, an egg is released from one ovary, travels down the fallopian tube on that side, and then enters the uterus.

It's normal for sperm to reach and fertilize an egg while it's still in the fallopian tube. The egg should then continue on its path to the uterus, where it implants in the uterine wall. Unfortunately, the egg occasionally attaches to the wall of the fallopian tube instead.

Who Is At Risk

Tubal pregnancies happen in about 1 in 40 to 1 in 100 pregnancies, often with no clear explanation. However, anything that interferes with the movement of the egg can increase a woman's risk. Things that make a tubal pregnancy more likely include:

• Having a history of pelvic inflammatory disease (PID). PID is a severe infection caused by the sexually transmitted diseases gonorrhea and chlamydia.
• Having had abdominal surgery. Internal scarring can affect the fallopian tubes.
• Having an IUD, having a tubal ligation (also called "having your tubes tied"), or taking birth control pills. All of these are very effective at preventing pregnancy. If pregnancy does occur, there's an increased chance that it will be ectopic.
• Attempting reversal of a tubal ligation. Scarring in the fallopian tubes can increase the risk.
• Being older. Women who are 35-44 years old have the highest risk of any age group.

Why Tubal Pregnancies Are Dangerous

It's extremely rare for a tubal pregnancy to continue to term. Instead, what generally happens is that as the embryo develops, it becomes too large for the small space inside the fallopian tube. If the embryo continues to grow, the tube eventually ruptures, causing severe internal bleeding. Without prompt treatment, the woman can go into shock and die.

For this reason, doctors recommend terminating ectopic pregnancies. This can be done with medication or with surgery. Once the tube has ruptured, emergency surgery is usually needed to stop the bleeding.

Recognizing the Signs and Symptoms of Tubal Pregnancy

The early signs and symptoms of tubal pregnancy are easy to miss. At first, it might seem like a normal pregnancy: periods stop, a pregnancy test is positive, and symptoms of pregnancy such as breast tenderness and nausea appear. However, there are some classic symptoms to look for:

• Pain or cramping in the pelvis or lower abdomen, especially one-sided
• One or more missed periods
• Vaginal bleeding or spotting (but not a normal period)

Most tubal pregnancies are discovered in the first trimester, usually before the tenth week.

What the Doctor Will Look for

Because only about half of women with tubal pregnancies have the classic symptoms, a doctor who suspects ectopic pregnancy will look for other signs. These may include:

• An adnexal mass. "Adnexa" is the medical term for the area near the uterus which includes the ovaries and fallopian tubes. Normally, the ovaries are small and difficult to feel. A larger mass in the adnexa may be a tubal pregnancy.
• An abnormal pregnancy blood test. A blood test not only confirms the pregnancy, but gives the doctor clues about whether it's in the uterus or the fallopian tube. The level of pregnancy hormone normally rises steadily. A slower rise can signal an abnormal pregnancy.
• A negative ultrasound. The doctor will use an ultrasound machine to examine the uterus. If no pregnancy is seen, the embryo may be developing in the fallopian tube.
• Low progesterone levels. Progesterone is elevated in a normal pregnancy. A level that's too low can mean a tubal pregnancy or some other problem with the embryo.

If the Tube Ruptures

If rupture occurs, the signs and symptoms of tubal pregnancy become much more serious. A ruptured tubal pregnancy is a medical emergency. There may be severe pelvic or abdominal pain, sometimes with pain in the shoulder as well. Internal bleeding can cause lightheadness and sometimes fainting.

If the bleeding is very severe, blood loss leads to a drop in blood pressure. This can result in decreased blood flow throughout the body. Most women reach the hospital in time to be treated; without medical care, the woman may die. In fact, tubal pregnancy causes about 9% of all pregnancy-related deaths in the U.S.

Conditions the Mimic the Signs and Symptoms of Tubal Pregnancy

It's possible for both patients and doctors to confuse other medical problems with the signs and symptoms of tubal pregnancy. Conditions that can seem similar include:

• Appendicitis
• Miscarriage
• Infection
• Ovarian torsion (twisting of an ovary)

All of these conditions require medical treatment. If you're being treated for one of them but are concerned about the possibility of tubal pregnancy, be sure to tell the doctor who provides your care.

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