Tubal Pregnancy

A tubal pregnancy, also called an ectopic pregnancy, happens when a woman's egg implants in her fallopian tube instead of her uterus.

The fallopian tubes connect the ovaries to the uterus. A woman has two ovaries, one on each side in her pelvis. Each month during a normal menstrual cycle, an egg is released from one of the ovaries, travels down the fallopian tube on that side, and enters the uterus. If the egg is fertilized by a man's sperm, it will implant in the uterus and begin to grow into a baby. The uterus is designed to enlarge as the baby grows.

Occasionally, a fertilized egg will implant in the fallopian tube and begin to develop there. But, there isn't room in the fallopian tube for a baby to develop. As the fetus grows, it will rupture the tube and cause severe internal bleeding.

Tubal pregnancies are the leading cause of pregnancy-related death during the first trimester; they must be terminated to protect the woman's life.

Any woman can have a tubal pregnancy. It happens in about 2% of pregnancies, and doctors aren't always sure why.

Women who have scarring in their fallopian tubes are at higher risk. Scarring can be caused by pelvic inflammatory disease, which is a complication of gonorrhea or chlamydia. It can also be caused by a prior tubal pregnancy. Women who become pregnant in spite of having tubal sterilization (often called "having your tubes tied") will have tubal pregnancies between 35 and 50% of the time. Other abdominal or pelvic surgeries or infections may also increase a woman's risk.

Risk of ectopic pregnancy is also increased by:

• certain types of IUDs (if the woman becomes pregnant with the IUD in place)
• a woman's mother having taken a medicine called diethylstilbestrol (DES) while pregnant with her
• fertility drugs
• increased age
• certain abnormalities in a woman's reproductive system

Tubal pregnancies seem like normal pregnancies at first. They are usually discovered in the first trimester, sometime during the first 5-10 weeks. They are often diagnosed when the woman begins to have abdominal or pelvic pain from the stretched fallopian tube. There may be vaginal bleeding, with or without pain. If internal bleeding occurs, the woman may feel dizzy or even pass out. In some cases, a woman will have shoulder pain instead of abdominal pain; this is because pain can radiate along nerves that are not directly involved.

A blood test for the pregnancy hormone human chorionic gonadotropin (HGC) will probably be abnormal. Sometimes this test will be repeated over several days, because it changes in a predictable way with ectopic pregnancy. An ultrasound will reveal that the uterus is empty and help the doctor discover the location of the pregnancy in the fallopian tube. The ultrasound may need to be done by inserting the ultrasound probe into the vagina, because that gives the best view of the uterus and fallopian tubes.

If the fallopian tube has not ruptured and the tubal pregnancy is caught very early, one treatment is medication to terminate the pregnancy. If all goes well, the pregnancy tissue will be reabsorbed into the woman's body.

In many cases, laparoscopic surgery is done to remove the pregnancy. This involves making small incisions in the abdomen, inserting a camera with very small surgical tools, and removing the pregnancy while attempting to preserve the fallopian tube.

If the tube has ruptured, the treatment is surgery. The tube on that side will usually need to be removed along with the pregnancy. Sometimes the ovary must be removed as well.

A woman does not need both of her fallopian tubes to become pregnant. About 85% of woman who have tubal (ectopic) pregnancies are able to have normal pregnancies at a later date.

Having a tubal pregnancy does increase your risk of having another one. The chance of having a second tubal pregnancy is between 10 and 25%.

If you have had a tubal pregnancy and want to become pregnant again, you should talk to your doctor about your personal risk factors.

Being pregnant can be a very exciting time. Although ending a tubal pregnancy is necessary to protect a woman's life, it can be just as sad as losing a pregnancy to miscarriage. If you've had a tubal pregnancy, don't be afraid to take time to grieve. Your partner, family, and friends may be able to provide support. If you're having trouble coping, your doctor or midwife may be able to connect you with a counselor who can help.

• Medline Plus from the National Institutes of Health. Look in the medical encyclopedia, or search "Tubal Pregnancy" for more links.
• The Mayo Clinic. Look in Diseases and Conditions for "Ectopic Pregnancy."

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