Ectopic Pregnancy

In the first few weeks, an ectopic pregnancy usually causes 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 pain or pelvic pain. It most often starts 6 to 8 weeks after a missed period.
• Vaginal bleeding. It may be light.

As an ectopic pregnancy progresses, though, other symptoms may develop. They include:

• Belly pain or pelvic pain that may get worse with movement or straining. It may be sharp on one side at first and then spread through your belly. It may be worse when you move or strain.
• Heavy or severe vaginal bleeding.
• Pain with intercourse or during a pelvic exam.
• Dizziness, lightheadedness, or fainting (syncope) caused by internal bleeding.
• Signs of shock.
• Shoulder pain caused by bleeding into the belly under the diaphragm. The bleeding irritates the diaphragm and is felt as shoulder pain.

Symptoms of miscarriage often are similar to symptoms in early ectopic pregnancy.

Fallopian tube damage is a common cause of ectopic pregnancy. A fertilized egg can get caught in the damaged area of a tube and start to grow there. Some ectopic pregnancies occur without any known cause.

Common causes of fallopian tube damage that may lead to an ectopic pregnancy include:

• Smoking. It raises the risk for ectopic pregnancy. Smoking is thought to damage the fallopian tubes' ability to move the fertilized egg toward the uterus.
• Pelvic inflammatory disease (PID), such as from a chlamydia or gonorrhea infection. PID can create scar tissue in the fallopian tubes.
• Being exposed to the chemical DES before you were born.

Some medical treatments can increase your risk. These include:

• Surgery on the fallopian tubes or in the pelvic area.
• Fertility treatments such as in vitro fertilization.

You may be able to prevent an ectopic pregnancy by reducing things that may put you at risk for having one.

If you smoke, quit. Smoking puts you at higher risk for ectopic pregnancy.

Use safer sex practices, such as using a condom every time you have sex. Use an external condom, which goes on the penis. Or use an internal condom, which goes into the vagina or anus. This will help protect you from sexually transmitted infections (STIs) that can lead to pelvic inflammatory disease (PID). PID is a common cause of scar tissue in the fallopian tubes, which can cause ectopic pregnancy.

If you have one or more risk factors for ectopic pregnancy, you and your doctor can closely monitor your first weeks of a pregnancy.

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 tube is damaged. In most cases, one or more shots of a medicine called methotrexate will end the pregnancy. Taking the shot lets you avoid surgery, but it can cause side effects. You will need to see your doctor for follow-up blood tests to make sure the shot worked.

For a pregnancy that has gone beyond the first few weeks, surgery is safer and more likely to work than medicine. If possible, the surgery will be laparoscopy. This type of surgery is done through one or more small cuts (incisions) in your belly. If you need emergency surgery, you may have a larger incision.

Call 911 anytime you think you may need emergency care. For example, call if:

• You have sudden, severe pain in your belly or pelvis.
• You passed out (lost consciousness).
• You have severe vaginal bleeding.

Call your doctor now or seek immediate medical care if:

• You are dizzy or lightheaded, or you feel like you may faint.
• You have new or increased pain in your belly or pelvis.
• Your vaginal bleeding is getting worse.
• You have increased pain in the vaginal area.
• You have new pain in your shoulder.
• You have a fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You have new or worse vaginal discharge.
• You do not get better as expected.