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Ectopic Pregnancy

By Antonette T. Dulay, MD, The Ohio State University College of Medicine

Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location.

  • Women may have abdominal pain and vaginal bleeding.

  • Ultrasonography is done, mainly to determine the location of the fetus.

  • Usually, surgery is done to remove the fetus and placenta, but sometimes a single dose of methotrexate is used to end the ectopic pregnancy.

Normally, an egg is fertilized in the fallopian tube and becomes implanted in the uterus. However, if the tube is narrowed or blocked, the fertilized egg may never reach the uterus. Sometimes the fertilized egg then implants in tissues outside of the uterus, resulting in an ectopic pregnancy. Ectopic pregnancies usually develop in one of the fallopian tubes (as a tubal pregnancy) but may develop in other locations.

A fetus in an ectopic pregnancy sometimes survives for several weeks. However, because tissues outside the uterus cannot provide the necessary blood supply and support, ultimately the fetus does not survive. The structure containing the fetus typically ruptures after about 6 to 16 weeks, long before the fetus is viable. When an ectopic pregnancy ruptures, bleeding may be severe and even life threatening. The later the structure ruptures, the worse the blood loss, and the higher the risk of death.

One of 200 pregnancies is an ectopic pregnancy.

Risk factors for an ectopic pregnancy include

  • A disorder of the fallopian tubes

  • Previous pelvic inflammatory disease

  • A previous ectopic pregnancy

  • A previous surgical procedure such as an abortion or tubal ligation (a sterilization procedure)

  • Current use of an IUD

Ectopic Pregnancy: A Mislocated Pregnancy

Normally, an egg is fertilized in the fallopian tube and becomes implanted in the uterus. However, if the tube is narrowed or blocked, the egg may move slowly or become stuck. The fertilized egg may never reach the uterus, resulting in an ectopic pregnancy.

An ectopic pregnancy may be located in many different places, including a fallopian tube, an ovary, the cervix, and the abdomen.


Symptoms include vaginal bleeding or spotting, cramping or pain in the lower abdomen, or both. Some women have no symptoms until the structure containing the ectopic pregnancy ruptures. If the structure ruptures, the woman usually feels severe, constant pain in the lower abdomen. If the woman has significant blood loss, she may faint, sweat, or feel light-headed. These symptoms may indicate that she has lost so much blood that she has dangerously low blood pressure (shock).


Doctors suspect an ectopic pregnancy in women who are of childbearing age and who have lower abdominal pain or vaginal bleeding, faint, or go into shock. In such women, a pregnancy test is done. If the pregnancy test is positive, ultrasonography is done using a probe inserted into the vagina. If ultrasonography detects a fetus in a location other than its usual place in the uterus, the diagnosis is confirmed. If ultrasonography does not detect a fetus anywhere, ectopic pregnancy is still possible, or the pregnancy may be in the uterus but be so early that it cannot be seen. Doctors do blood tests to measure a hormone produced by the placenta early in pregnancy called human chorionic gonadotropin (hCG). This test can help doctors determine whether the pregnancy is too early for the fetus to be visible in the uterus or is an ectopic pregnancy.

If needed to confirm the diagnosis, doctors may use a viewing tube called a laparoscope, inserted through a small incision just below the navel. This procedure enables them to view an ectopic pregnancy directly.


An ectopic pregnancy must be ended as soon as possible to save the life of the woman. In most women, the fetus and placenta must be removed surgically, usually with a laparoscope but sometimes through a larger incision in the abdomen (in a procedure called laparotomy). During surgery, doctors may remove the entire fallopian tube containing the fetus and placenta. Or they may open the tube, remove the fetus and placenta, and leave the fallopian tube in place without sewing it closed. However, leaving the fallopian tube in place increases the risk of future ectopic pregnancies. Rarely, the uterus is so damaged that a hysterectomy is required.

Often, the drug methotrexate, given by injection, can be used instead of surgery. The drug causes the ectopic pregnancy to shrink and disappear. Occasionally, surgery is needed in addition to methotrexate.

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