Ectopic Pregnancy is defined as a pregnancy not in the uterus. Ninety percent of the time an ectopic pregnancy occurs in the fallopian tube. It can also be in rare locations such as the abdomen, ovary, cervix or even in the area of a previous cesarean scar. The United States reports about hundred thousand ectopic pregnancies a year.
Potentially any woman is at risk for an ectopic pregnancy. However, previous damage to the fallopian tube can increase your risk factor.
The most common risk factors are:
- Previous ectopic pregnancy
- History of tubal surgery, including previous tubal sterilization
- History of sexually transmitted infection
- Tubal infection
- Pelvic adhesions
- Cigarette smoking
All pregnancies will draw a large blood supply to the location of the embryo. The uterus is a very large muscle and will enlarge with the pregnancy as the blood supply increases. Other organs, especially the fallopian tube is not capable of accommodating a growing embryo and structurally will rupture. At the time of rupture, the blood supply to the pregnancy will unfortunately continue and the pregnant woman is then at risk for shock. Therefore, a ruptured ectopic pregnancy is an emergency and will require a surgical intervention. On the other hand, if diagnosed early, ectopic pregnancies can be managed medically. Our goal at Dominion Fertility is to be able to diagnose all ectopic pregnancies early on so we can treat them medically.
Methotrexate is a folic acid antagonist and will lead to cessation of cell division. It will stop the early embryo from growing. The medication can be given only under certain conditions and the treatment requires close monitoring. This medication can be toxic to many other cell and requires the patient to be healthy. We may not give methotrexate to patients with peptic ulcer disease, kidney disease, liver disease or pulmonary disease. It is administered in the form of an intramuscular shot in the clinic. Patients are then asked to report for blood draws every few days. If the pregnancy is not resolving as expected, patient will be given a repeat dose or counseled on surgical intervention. The success rates can be as high as 80-90% with medical management.
Most patients ask about their ability to conceive after medical treatment of an ectopic pregnancy. There are few studies that documented 75% tubal patency after treatment with methotrexate and up to 65% successful pregnancy rate. Patients with history of an ectopic pregnancy should always remember that their risk for a repeat ectopic can be as high as 20% and they immediately need to report to their OB/GYNS or Fertility Doctor with a missed menstrual cycle.
, once our patients become successfully pregnant we continue to follow them with frequent lab draws and ultrasounds very early in their pregnancy, even before their OB/GYNS require. Our goal is to make sure a possible ectopic pregnancy does not go undiagnosed. Early detection and timely diagnosis of an ectopic pregnancy is crucial. It will lead to a reduced risk of rupture and will improve the success of medical management.