How To Diagnose Ectopic Pregnancy

Can I Prevent An Ectopic Pregnancy

An ectopic pregnancy cannot be prevented. But you can try to reduce your risk factors by following good lifestyle habits. These can include not smoking, maintaining a healthy weight and diet, and preventing any sexually transmitted infections . Talk to your healthcare provider about any risk factors you may have before trying to become pregnant.

Identification And Assessment Of Evidence

This guideline was developed in accordance with standard methodology for producing Royal College of Obstetricians and Gynaecologists Green-top Guidelines. MEDLINE, EMBASE and the Cochrane Library were searched. The search was restricted to articles published between 1995 and July 2015 and limited to humans and the English language. The databases were searched using the relevant Medical Subject Headings terms and this was combined with a keyword search. Search terms included ectopic pregnancy, tubal pregnancy, interstitial pregnancy, cornual pregnancy, cervical pregnancy, caesarean scar pregnancy, ovarian pregnancy, abdominal pregnancy, heterotopic pregnancy, pregnancy of unknown location and extrauterine pregnancy. The National Guideline Clearinghouse, NICE Evidence Search and Trip were also searched for relevant guidelines. Where possible, recommendations are based on available evidence. Areas lacking evidence are highlighted and annotated as good practice points .

Further information about the assessment of evidence and the grading of recommendations may be found in Appendix .

Why Does An Ectopic Pregnancy Happen

In a normal pregnancy an egg is fertilised by sperm in one of the fallopian tubes, which connect the ovaries to the womb. The fertilised egg then moves into the womb and implants itself into the womb lining , where it grows and develops.

An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb. It most commonly occurs in a fallopian tube , often as the result of damage to the fallopian tube or the tube not working properly.

Less commonly , an ectopic pregnancy can occur in an ovary, in the abdominal space or in the cervix .

In many cases, it’s not clear why a woman has an ectopic pregnancy. Sometimes it happens when there’s a problem with the fallopian tubes, such as them being narrow or blocked.

The following are all associated with an increased risk of ectopic pregnancy:

• increasing age the risk is highest for pregnant women who are aged 35-40

In around half of all cases, there are no obvious risk factors.

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Ectopic Pregnancy Causes And Risk Factors

You may never know why you have an ectopic pregnancy. One cause could be a damaged fallopian tube. It could keep the fertilized egg from getting into your uterus.

Youre more likely to have an ectopic pregnancy if you:

• Have a sexually transmitted infection
• Have scarring from pelvic surgery
• Had a previous ectopic pregnancy
• Had fertility treatments such as in vitro fertilization

It could also happen if you become pregnant while you have an intrauterine device for birth control.

Ectopic Pregnancy: Sign Symptoms Causes And Treatment

Naturally, the fertilized egg makes its way to the uterus, where it implants in the lining of the uterus and the fetus continues to grow. But in the case of an ectopic pregnancy , the fertilized egg implants outside the uterus, and 97 percent of cases of ectopic pregnancy occur in one of the fallopian tubes, although it can also occur in the cervix, on the ovary or In the stomach.

Here we healthy queries did a comprehensive study and bring up to you the causes of ectopic pregnancy, symptoms of ectopic pregnancy, how to diagnose ectopic pregnancy, and how to handle ectopic pregnancy and endoscopic surgery.

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What Are The Long

In the absence of a history of subfertility or tubal pathology, women should be advised that there is no difference in the rate of fertility, the risk of future tubal ectopic pregnancy or tubal patency rates between the different management methods.

Grade of recommendation: D

Womenwitha previous history of subfertility should be advised that treatment of their tubal ectopic pregnancy with expectant or medical management is associated with improved reproductive outcomes compared with radical surgery.

Grade of recommendation: C

Women receiving methotrexate for the management of tubal ectopic pregnancy can be advised that there is no effect on ovarian reserve.

Grade of recommendation: D

Women undergoing treatment with uterine artery embolisation and systemic methotrexate for nontubal ectopic pregnancies can be advised that live births have been reported in subsequent pregnancies.

Grade of recommendation: D

Women undergoing laparoscopic management of ovarian pregnancies can be advised that their future fertility prospects are good.

Grade of recommendation: D

Whats The Treatment For An Ectopic Pregnancy

A pregnancy wont survive if its ectopic, because a fertilized egg cant grow fully outside your uterus.

Ectopic pregnancy treatment is medicine or surgery:

• You get shots of a medicine called methotrexate that ends the ectopic pregnancy. It stops the fertilized eggs cells from growing, and your body absorbs any cells that have already developed. This shouldnt damage the fallopian tubes at all.

• The pregnancy is removed with a surgical procedure using laparoscopy. Your doctor makes a small cut near your belly button, and removes the pregnancy using surgical tools and a tiny camera to see inside your body. This is the most common treatment for ectopic pregnancy. Sometimes, this procedure causes scarring in your fallopian tube, or a piece of fallopian tube needs to be removed.

Your doctor will talk with you about what treatment is best for you.

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What Else Should I Know

Any woman can have an ectopic pregnancy. But the risk is higher for women who are older than 35 and those who have had:

• PID
• surgery on a fallopian tube
• infertility problems or medicine to stimulate ovulation

Some birth control methods also can affect a woman’s risk of ectopic pregnancy. Those who become pregnant while using an intrauterine device might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also increase the risk of an ectopic pregnancy.

Has Any Baby Survived An Ectopic Pregnancy

Doctors have hailed as amiracle the birth of a baby who beat odds of 60m to one to become the first to develop outside the womb and live. Not only did the baby boy and his mother survive an ectopic pregnancy but so did two other baby girls. Ronan Ingram was one of three children born to Jane Ingram, 32.

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Hcg And Progesterone Blood Tests

The hormone hCG is produced during pregnancy by the early developing placenta regardless of where the pregnancy is. HCG can first be detected by a blood test approximately 11 days after conception and, in a healthy pregnancy, will typically increase during the first 8 to 11 weeks of pregnancy, then fall or level off for the remainder of the pregnancy. It is hCG that leads to the âmorning sicknessâ some experience in early pregnancy.

Progesterone is the hormone made by the corpus luteum cyst, which forms on the ovary after every ovulation. If not pregnant, progesterone is only made for two weeks, after which the corpus luteum disappears, a period starts, and a new cycle begins. In pregnancy, this cyst is encouraged to remain and continue releasing progesterone for the first 13 weeks of pregnancy.

HCG and progesterone are used to guide the management of a PUL. The progesterone is measured at the time of a first visit by some doctors, whilst the hCG is measured at the first visit and then in most cases 48 hours later. . Low progesterone and falling hCG levels may indicate the pregnancy is no longer growing, or that the pregnancy has unfortunately already passed as a miscarriage.

HCG is also used to help decide the best way to treat an ectopic pregnancy. These results will be assessed by your doctor alongside your symptoms and your ultrasound scan findings.

Symptoms Of An Ectopic Pregnancy

The early signs of an ectopic pregnancy are like those of a normal pregnancy:

• Missed periods
• A positive home pregnancy test

The first warning signs of ectopic pregnancy may include:

• Abnormal vaginal bleeding
• Mild pain in the abdomen or pelvis
• Mild cramping on one side of the pelvis

If you have any of these symptoms, you should call your doctor.

As an ectopic pregnancy grows, it may rupture. Then you may experience more serious symptoms. These could include:

• Sudden, severe pain in the abdomen or pelvis
• Shoulder pain
• Feeling weak, faint, or dizzy

If you experience these symptoms, get medical help right away.

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How Is A Cervical Pregnancy Diagnosed

4.2.1 What are the ultrasound criteria?

The following ultrasound criteria may be used for the diagnosis of cervical ectopic pregnancy: an empty uterus, a barrel-shaped cervix, a gestational sac present below the level of the internal cervical os, the absence of the sliding sign and blood flow around the gestational sac using colour Doppler.

Grade of recommendation: D

Cervical pregnancies are rare, accounting for less than 1% of all ectopic gestations. Defined criteria have been described for diagnosing cervical ectopic pregnancies.,

The following ultrasound criteria have been described in the diagnosis of cervical ectopic pregnancy:

The sliding sign enables cervical ectopic pregnancies to be distinguished from miscarriages that are within the cervical canal. When pressure is applied to the cervix using the probe, in a miscarriage, the gestational sac slides against the endocervical canal, but it does not in an implanted cervical pregnancy.

Evidence level 3

4.2.2 What biochemical investigations should be carried out?

A single serum -hCG should be carried out at diagnosis.

Grade of recommendation: D

Evidence level 3

Getting Pregnant Again After Ectopic Pregnancy

Having an ectopic pregnancy should have little bearing on your future fertility. Even if you lost a fallopian tube, the other tube should take over.

Some research has shown that about two-thirds of women treated for ectopic pregnancy conceive and have a normal pregnancy within two years. On average, about 85 percent of couples who haven’t experienced ectopic pregnancy conceive within one year of trying.

Be aware that having one ectopic pregnancy does increase your risk of having another, and the same factors that led to it in the first place may be still at work.

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect When You’re Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading our medical review and editorial policy.

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What Is An Ectopic Pregnancy

An ectopic pregnancy is a pregnancy that happens outside of the uterus. This happens when a fertilized egg implants in a structure that cant support its growth. An ectopic pregnancy often happens in the fallopian tube . In rare cases, an ectopic pregnancy can occur on an ovary or in the abdominal cavity.

This is a life-threatening condition. An ectopic pregnancy is not a pregnancy that can be carried to term and can be dangerous for the mother if not treated right away.

Who Is At Risk For Having An Ectopic Pregnancy

Any woman can have an ectopic pregnancy. But the risk is higher if you:

• Are older than 35
• Smoke
• Have more than one sex partner. This can put you at risk for getting a sexually transmitted infection . An STI is an infection you can get from having sex with someone who is infected. STIs can lead to pelvic inflammatory disease , an infection that can damage the fallopian tubes, uterus and other organs.

Medical conditions that increase your risk for having an ectopic pregnancy include:

• You’ve had a previous ectopic pregnancy.
• You’ve had surgery on a fallopian tube, or you have problems, like a birth defect in a fallopian tube. A birth defect is a health condition that is present at birth. It can change the shape or function of one or more parts of the body. It can cause problems in overall health, in how the body develops, or in how the body works.
• You have scars inside the pelvic area from a burst appendix or from past surgeries. Your appendix is part of your digestive tract that helps you process the food you eat.
• You’ve had endometriosis. This is when tissue from the uterus grows somewhere outside the uterus.
• You had trouble getting pregnant, or you had fertility treatment to help you get pregnant.
• You got pregnant while using an intrauterine device or after tubal ligation . An IUD is a form of birth control that your provider places inside your uterus. Tubal ligation is surgery to close the fallopian tubes to prevent you from getting pregnant.

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What Is The Treatment For An Ectopic Pregnancy

The management of ectopic pregnancies has shifted towards medical rather than surgical intervention. The drug methotrexate has been successfully used for many years now. Methotrexate kills the pregnancy cells and any pregnancy tissue is then progressively absorbed.

In the event that it is too late to use methotrexate, the affected fallopian tube can be removed through keyhole surgery . However, in cases where it is not possible to successfully remove the fallopian tube through keyhole surgery, the abdomen is opened and the tube removed.

How Can You Tell If Your Pregnant By Your Stomach

Walk your fingers up the side of her abdomen until you feel the top of her abdomen under the skin. It will feel like a hard ball. You can feel the top by curving your fingers gently into the abdomen. Figure 10.1 With the woman lying on her back, begin by finding the top of the uterus with your fingers.

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Unusual Sites Of Implantation

Over 98% of ectopic pregnancies implant in the Fallopian tube, in its ampullary region , isthmus or fimbria . Interstitial or cornual ectopics, where the pregnancy implants in the intramyometrial portion of the Fallopian tube, are less common but have a mortality twice that of any other type of Fallopian tube ectopic pregnancy.77 Rarely, an ectopic pregnancy implants at an extratubal location, such as the cervix, ovary, abdomen, liver, spleen or Caesarean section scar. This produces a diagnostic challenge and colour Doppler visualisation aids in the identification of the ectopic pregnancy by creating awareness of vasculature supplying the implanted gestation.77 Surgical treatment is difficult and systemic methotrexate is considered first-line treatment, with an early recourse to more than one dose, for the majority of extratubal ectopic pregnancies.78 A more detailed description of the management of these unusual cases is beyond the scope of this review.

Coping With Pregnancy Loss

Although it occurs early on, an ectopic pregnancy is a loss just like any other miscarriage especially if youve been planning for a child. You may feel sad or shocked, and healing emotionally can take time. Lean on your friends and family for support following a pregnancy loss, and consider a support group or grief counseling.

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Do I Have An Ectopic Pregnancy

Getting checked out by a doctor is the only way to know for sure if you have an ectopic pregnancy. Your doctor or nurse may do a pelvic exam, blood test, or ultrasound to find out.

The sooner you get treated for an ectopic pregnancy, the better. So if you think you have an ectopic pregnancy, or if you have lots of low belly pain or abnormal vaginal bleeding, call your nurse or doctor right away.

Diagnosis Of Viable Intrauterine Pregnancy And Of Tubal Ectopic Pregnancy

1.4.1.

Offer women who attend an early pregnancy assessment service a transvaginal ultrasound scan to identify the location of the pregnancy and whether there is a fetal pole and heartbeat.

1.4.2.

Consider a transabdominal ultrasound scan for women with an enlarged uterus or other pelvic pathology, such as fibroids or an ovarian cyst.

1.4.3.

If a transvaginal ultrasound scan is unacceptable to the woman, offer a transabdominal ultrasound scan and explain the limitations of this method of scanning.

Using ultrasound scans for diagnosis of viable intrauterine pregnancy

Using ultrasound scans for diagnosis of tubal ectopic pregnancy

To find out why the committee made the 2019 recommendations on using ultrasound scans for diagnosis of tubal ectopic pregnancy, and how they might affect practice, see .

Human chorionic gonadotrophin measurements in women with pregnancy of unknown location

1.4.30.

For a woman with a decrease in serum hCG levels greater than 50% after 48 hours:

• inform her that the pregnancy is unlikely to continue but that this is not confirmed and
• provide her with oral and written information about where she can access support and counselling services. See also for details of further information that should be provided
• ask her to take a urine pregnancy test 14 days after the second serum hCG test, and explain that:

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How Do I Know If Im At Risk Of An Ectopic Pregnancy

There are several risk factors that could increase your chance of developing an ectopic pregnancy. A risk factor is a trait or behavior that increases your chance for developing a disease or condition. You may be at a higher risk of developing an ectopic pregnancy if youve had:

• A previous ectopic pregnancy.
• A history of pelvic inflammatory disease , an infection that can cause scar tissue to form in your fallopian tubes, uterus, ovaries and cervix.
• Surgery on your fallopian tubes or on the other organs of your pelvic area.
• A history of infertility.
• An intrauterine device , a form of birth control, in place at the time of conception.
• A history of smoking.

Your risk can also increase as you get older. Women over age 35 are more at risk than younger women.

Many women who experience an ectopic pregnancy dont have any of the above risk factors.