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JAMA Patient Page
August 22/29, 2012

Ectopic Pregnancy

JAMA. 2012;308(8):829. doi:10.1001/jama.2012.6215

A woman's reproductive system includes the uterus, the ovaries, and the fallopian tubes. In a healthy pregnancy, the fertilized egg implants on the uterine wall. The growing fetus develops, nourished by the placenta, for about 40 weeks until the fetus is ready for delivery. When a fertilized egg does not make it all the way to the uterus and stays in the fallopian tube (or rarely in the ovary or in the abdominal cavity), an ectopic (out-of-place) pregnancy exists. The abnormally placed cells of an ectopic pregnancy cannot become normally placed inside the uterus or develop into a normal pregnancy.

RISK FACTORS

  • Past ectopic pregnancies

  • Past operations on the fallopian tubes or ovaries

  • Scar tissue from other abdominal or pelvic surgery

  • History of pelvic infections

  • Endometriosis

  • Smoking

  • In vitro fertilization

SIGNS AND SYMPTOMS

  • Symptoms similar to a healthy pregnancy, such as missed menstrual periods, breast tenderness, back pain, or nausea

  • Abdominal, pelvic, or rectal pain

  • Vaginal bleeding

  • Dizziness, paleness, fainting, and even shock can happen if the ectopic pregnancy ruptures (bursts open) and causes bleeding.

DIAGNOSIS

A medical history that is taken will include questions about sexual activity and the possibility of pregnancy. Physical examination may reveal abdominal or pelvic tenderness, especially during vaginal or rectal examination. A pregnancy test is done, including a blood test for levels of a hormone called beta human chorionic gonadotropin (beta-HCG), because a healthy pregnancy shows a different amount of increasing beta-HCG. Your doctor will look for signs of anemia. An abdominal and pelvic ultrasound is often performed, looking for whether a pregnancy can be seen inside the uterus and whether an ectopic pregnancy can be seen outside the uterus (for example, in the fallopian tube). This ultrasound also looks for blood in the abdominal cavity or in the pelvis (a result of rupture of the ectopic pregnancy).

TREATMENT

In some cases, if an ectopic pregnancy is discovered, a medication called methotrexate may be used as treatment. In other cases, in particular when a ruptured ectopic pregnancy has occurred, a laparoscopy (using instruments to look into the abdomen and pelvis through small incisions) or a laparotomy (in which the abdomen is surgically opened) may be done to remove the ectopic pregnancy. Sometimes the fallopian tube must be removed (salpingectomy).

Also, if there has been a significant amount of bleeding, support of the blood circulation may be required, including intravenous (through a vein) fluids and sometimes blood transfusion.

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA's website at www.jama.com. Many are available in English and Spanish. A Patient Page on smoking and pregnancy was published in the March 9, 2005, issue; one on prenatal care was published in the January 7, 2004, issue; and one on miscarriage was published in the October 16, 2002, issue.

Sources: US Department of Health and Human Services Office on Women's Health, American Congress of Obstetricians and Gynecologists

Topic: WOMEN'S HEALTH

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

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