Ectopic pregnancy

In an ectopic pregnancy, the fertilized egg attaches (or implants) someplace other than the uterus. It attaches most often in the fallopian tube. (This is why it's sometimes called a tubal pregnancy.) In rare cases, the egg implants in an ovary, the cervix, or the belly.

In a normal pregnancy, a fertilized egg travels through a fallopian tube to the uterus, where the egg attaches and starts to grow.

An ectopic pregnancy cannot turn into a normal pregnancy. If the egg keeps growing in the fallopian tube, it can damage or burst the tube. This can cause heavy bleeding that could be deadly. If you have an ectopic pregnancy, you will need to be checked by your doctor right away.

In the first few weeks, an ectopic pregnancy may cause the same symptoms as a normal pregnancy, such as a missed menstrual period, fatigue, nausea, and sore breasts.

The key signs of an ectopic pregnancy are:

• Belly, pelvic, or shoulder pain. It most often starts 6 to 8 weeks after a missed period. The belly pain may be sharp on one side at first and then may spread.
• Vaginal bleeding. It may be light.

A urine test can show if you are pregnant. If you have symptoms of a possible ectopic pregnancy, you will have:

• A pelvic exam to check on the size of your uterus and feel for growths or tenderness in your belly.
• A blood test that checks for the level of the pregnancy hormone (hCG). This test is repeated 2 days later. Low or slowly increasing levels suggest a problem, such as an ectopic pregnancy.
• An ultrasound. This test can show pictures of what's inside your belly. With ultrasound, a doctor can usually see a pregnancy in the uterus 6 weeks after your last menstrual period.

During the week after treatment for an ectopic pregnancy, your hCG blood levels are tested several times. In some cases, hCG testing continues for weeks to months until hCG levels drop to a low level.

In some cases, you may have expectant management. This means your doctor monitors your pregnancy hormone (hCG) levels to check if they are dropping on their own. But in most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. The decision about which treatment to use depends on how early the pregnancy is found and your overall condition.

Medicine can be used if the pregnancy is found early, before the pregnancy has grown too big. In most cases, one or more shots of a medicine called methotrexate are given. You will need follow-up blood tests for several weeks to make sure the treatment worked.

Surgery may be used if the ectopic pregnancy is found later or is causing internal bleeding or high hCG levels. The surgery may be done through one or more small cuts (incisions) in your belly. If you need emergency surgery, you may have a larger incision.

Get plenty of rest. You may be tired for a few weeks. Use sanitary pads if you have vaginal bleeding. Avoid moving quickly, lifting anything heavy, or having vaginal sex until your doctor says it's okay. If you're treated with methotrexate, follow your doctor's instructions. Avoid alcohol and direct sunlight while taking this medicine.