Complications - miscarriage

Ectopic Pregnancy

• the use of IUDs for birth control
• any condition or treatment that may cause tubal scarring such as previous infection with gonorrhea or chlamydia and pelvic inflammatory disease. (learn more about sexually transmitted disease
• salpingitis (or infection of the fallopian tube)
• induced or elective abortion
• tubal ligation (for birth control)
• a history of previous ectopic pregnancy.

The most common site of ectopic pregnancy is the fallopian tube. Ectopic pregnancies pose serious risks including hemorrhage and death and must be treated as soon as possible. Early symptoms of ectopic pregnancy are lack of menstrual period, abdominal pain, and vaginal bleeding that is different from a normal menstrual period (vaginal bleeding will be milder, intermittent, dark red or brown). If the ectopic goes on to rupture (or burst) the diagnosis is more obvious. Symptoms include abdominal pain and swelling, sometimes shoulder pain, sweating, increased heart rate, dehydration and changes in blood pressure.

There are several tests that can help identify the presence of an ectopic pregnancy before complications arise. They are beta-hCG, serum progesterone and transvaginal ultrasound.

Human Chorionic Gonadotropin (beta-hCG)
This is a hormone secreted by the fetus that can be measured in maternal serum during pregnancy. Serial beta-hCGs may aid in early identification of ectopic pregnancy. Beta-hCG is the same substance measured in most pregnancy tests. In a normal pregnancy the beta-hCG rises predictably during the first ten weeks. With ectopic pregnancy the rate of rise of beta-hCG starts to look abnormal and then levels off at about six weeks. If the beta-hCG is abnormally rising, an ultrasound may help confirm the suspicion of ectopic pregnancy.

Serum progesterone
In a normal pregnancy the serum progesterone level is greater than 25 ng/ml. If the level is below 15 ng/ml an ectopic is suspected.

Transvaginal Ultrasound
Using ultrasound the characteristic changes of ectopic pregnancy can be identified with accuracy. The use of the vaginal probe permits close placement of the ultrasound to better visualize the pelvic structures and identify the location of an ectopic pregnancy.

Treatment of Ectopic Pregnancy
Once an ectopic pregnancy has been detected it must be managed quickly to avoid further growth and possible rupture into the abdominal cavity. Two surgical procedures are most commonly used, laparoscopy and laparotomy.

A laparoscopy uses a fiber optic scope to look at the fallopian tubes, uterus and abdominal cavity. Location and repair of the ectopic pregnancy can be performed using the laparoscope. Recovery is very quick because only small incisions are made into the abdomen to insert the laparoscope and remove the ectopic pregnancy.

Sometimes, a laparotomy must be performed to remove the ectopic pregnancy. Laparotomy involves an open incision in the lower abdomen usually along the bikini line to remove the ectopic pregnancy and repair the area where the rupture occurred. Recovery is longer after laparotomy due to the type of incisions made through the abdomen and muscles. This is usually performed only when the mother’s health is unstable, the ectopic pregnancy is too large for safe removal with a laparoscope, or previous scarring or adhesions make use of a laparoscope difficult.

Methotrexate injections are another method to treat ectopic pregnancy. Methotrexate is a chemotherapy agent that interferes with cell multiplication, causing the ectopic mass to dissolve. Methotrexate may be used in an otherwise healthy woman with early-identified ectopic pregnancies. This therapy requires blood work to be sure that your are not anemic and that liver and kidneys are functioning well. Following Methotrexate injection, you will have beta-hCGs drawn to make sure that the result returns to zero. This treatment has the quickest recovery. There are short-term side effects of the medication including anemia, stomach cramping, nausea and diarrhea.