Ectopic Pregnancy

Called an “Ectopic” for short, meaning “out of place;” sometimes called a “Tubal Pregnancy.”ย  This is when sperm meets egg creating a pregnancy, which gets stuck in the Fallopian Tube instead of making its way to the uterus (see Diagram — Female Genital Anatomy).ย  Eventually, as the pregnancy grows, the tube ruptures, causing major hemorrhage and death.ย  If diagnosed early enough, it can often be cured by medicine, or certainly by surgery.ย  This is a pregnancy that could never ever grow past 3 months.

Ectopic Pregnancy is a very tricky diagnosis; its symptoms can be subtle, and rupture can happen suddenly.  We worry about it whenever a woman of childbearing age (10 to 55) has new low abdominal pain.  There may or may not be some vaginal bleeding.  We especially worry about women at risk for Ectopics:

  • Previous Ectopic Pregnancy
  • Tubal surgeries or diseases (including STDs)
  • IUD (though maybe not)

The first step in diagnosis is a urine pregnancy test.  If negative, thereโ€™s no Ectopic (unless the person who did the test was in a hurry & didn’t wait the full amount of time, since the test usually shows up right away, but sometimes lingers to the end).  Also, the test may rarely be false-negative if the pregnancy is very recent, and the urine is very dilute (see Pregnancy Test).

If the pregnancy test is positive and the woman has new lower abdominal pain, she should go to an ER, where they can do an ultrasound.  If an ectopic is seen in a tube, the diagnosis is certain.  Then the question is whether it’s early enough to treat with medicines, which can save the tube for the future, or if surgery is necessary.  This is determined by signs of rupture (needs immediate surgery), and by repeated blood tests for hCG (the natural hormone of pregnancy), to see the pattern by which it’s increasing.

Often, an Ectopic is too small to see by ultrasound.  But if a pregnancy is seen within the uterus, that’s very reassuring.  However, there are cases of twin pregnancies, one in the uterus, one in the tube.  This is especially possible with women who have conceived by In-Vitro Fertilization (IVF).  Repeated blood tests for hCG determine this as well.

Sometimes we perform pregnancy tests in the most unlikely of situations, like on a 10-year-old girl, or a woman who hasn’t had sex for a year.  This is because a girl may be too confused or scared to tell us about sex, and some adults are not honest or forthcoming for a variety of psychological reasons.  So don’t be shocked if a clinician decides to do this for your young daughter — it’ll surely be negative, but how can we afford to miss the possibility of a life-threatening disease?

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