What You Need to Know About Tubal Pregnancy

What is a tubal pregnancy?

An ectopic pregnancy, commonly known as a tubal
pregnancy, is a pregnancy in which the fertilized egg
implants itself somewhere other than the uterus. It is
referred to as a tubal pregnancy because 95% of ectopic
pregnancies occur when the fertilized egg is unable
to travel all the way through the fallopian tube to the
uterus, and therefore implants itself in the tube.



Of all ectopic pregnancies, 1.5% are abdominal,
0.5% are ovarian, and 0.03% are cervical. None of
these places are suited for a growing baby. As the
fetus grows, it can eventually burst the organ that
contains it, causing severe internal bleeding, and
endangering the mother's life. Unfortunately, a tubal
pregnancy will never develop into a live birth.



Although there have been advances in surgical
technology that have caused the death rate due to
tubal pregnancy to drop since 1970, there is still a
death rate of about 1 out of 2000, with about 40-50
women dying each year in the U.S.



What causes tubal pregnancy?

There are many reasons why an egg may become
lodged in the fallopian tube. It is most often caused
by an infection or inflammation of the tube that
partially or entirely blocks the passage. Pelvic
inflammatory disease (PID) is the most common of these
infections.



Endometriosis, when cells from the lining of the
uterus detach and grow elsewhere in the body, can
cause blockages. Scar tissue from previous pelvic or
fallopian surgery can also lead to tubal pregnancy.
Less frequently, abnormal growths or birth defects
can alter the shape of the tube and obstruct the egg's
progress.



How will I know if I am having a tubal pregnancy?

It can be difficult to recognize symptoms of tubal
pregnancy since many of the early signs mirror those
of a normal pregnancy, such as missed periods,
breast tenderness, nausea, vomiting, or frequent
urination.



Some of the symptoms more specific to tubal
pregnancy are:



* Pain in your lower belly

* Slight bleeding from vagina

* One-sided pain in your stomach

* Shoulder pain (which may be caused by internal
bleeding irritating your diaphragm when you
breathe)

* Bladder or bowel problems

* Feeling light-headed or faint, sometimes
accompanied by paleness, increased pulse, diarrhea, and
falling blood pressure (caused by blood loss)

* Abnormal bleeding (heavier or lighter than usual
and prolonged, or dark and watery, almost like prune
juice)

* Lower back pain



If you experience any of these symptoms you should
go directly to the emergency room. If you arrive at the
hospital complaining about abdominal pains, you
will most likely be given a pregnancy test. Urine
pregnancy tests are not necessarily the best
pregnancy tests, but they are fast. Speed can be crucial in
dealing with a tubal pregnancy.



If the pregnancy test comes back positive then your
doctor will probably perform a quantitative hCG test
to measure the amount of human chorionic
gonadotropin in your body. hCG is a hormone produced by
the placenta which shows up in the blood and urine
as early as 10 days after conception. Its levels double
every day for the first 10 weeks of pregnancy. Lower-
than-expected hCG levels could indicate a tubal
pregnancy.



You will be given a pelvic exam as well, to find the
areas causing pain, check for an enlarged, pregnant
uterus, or locate any masses in your abdomen. The
doctors will probably also perform an ultrasound
examination, which would show if the uterus

contained a developing fetus or determine whether
there are masses growing elsewhere in the

abdomen. Unfortunately, the ultrasound may not be
able to detect every tubal pregnancy.



There is also a more rarely used test for tubal

pregnancy, called culdocentesis, which is used to
check for internal bleeding. This test is performed by
inserting a needle into the space at the very top of the
vagina, behind the uterus and in front of the rectum. If
there is blood or fluid found there, it most likely
comes from a ruptured tubal pregnancy.



What can be done about my tubal pregnancy?

Treatment for a tubal pregnancy will depend on its
size and location, and on whether or not you would
like the ability to conceive again.



If caught early enough, a tubal pregnancy may be
able to be treated with an injection of methotrexate,
which would dissolve the fertilized egg and allow it to
be reabsorbed into the body. This non-surgical
approach results in minimal scarring of the pelvic organs.



A tubal pregnancy that is further along will likely
require surgery to be removed. In the past, this
operation would have required a very large incision across
the lower abdomen, which may still be necessary in
cases of emergency or severe internal injury.



However, modern technology has bestowed upon us
an alternative method of removal. In many cases, the
vtubal pregnancy can be removed using
laparoscopy, a much less invasive surgical procedure. The
surgeon makes a small incision in the lower
abdomen and inserts a laparoscope, a long, hollow tube
with a lighted end. This allows the surgeon to see
internal organs and insert other instruments as need.
The tubal pregnancy is then removed, and the
damaged organs are repaired or removed.



Regardless of which procedure is used, the doctor
will want to continue seeing you regularly, to monitor
your hCG levels, which should return to zero. This
may take up to twelve weeks, but if the hCG levels do
not decline, it could mean that some of the ectopic
tissue was missed and may need to be removed
using methotrexate or additional surgery.



How will this affect my future pregnancies?

About a third of women with a previous tubal
pregnancy will have trouble conceiving again. This
depends mainly on the total amount of damage and
surgery that was done.



If the fallopian tubes remain intact, chances for a
successful pregnancy in the future are about 60%.
Even with only one fallopian tube, chances can be
greater than 40%.



The risk of a repeat tubal pregnancy is increased with
each subsequent tubal pregnancy. After your first
one, you face about a 15% chance of having another.



Am I at risk of having a tubal pregnancy?

Those most at risk of having a tubal pregnancy are
women between the ages of 35 and 45 who have
had a PID, a previous tubal pregnancy, surgery on a
fallopian tube, or infertility problems or medication to
stimulate ovulation.



Some birth control methods may also increase your
chances for a tubal pregnancy. If you become
pregnant while using progesterone intrauterine devices
(IUDs), progesterone-only oral contraceptives, or the
morning after pill, you may be more likely to have a
tubal pregnancy.



If you think that you may be at risk of tubal
pregnancy, talk to your doctor about it before attempting to
conceive. Although there is nothing that can be done
to prevent tubal pregnancy, if monitored closely it can
be detected early.



If you are pregnant and experience any of the
symptoms of tubal pregnancy, contact your doctor
immediately. Tubal pregnancy is just one of those things
that you want to have checked out, even if you only
have so much as a hunch. It can't hurt to be sure, and
it may save your life.