Ectopic pregnancy is also often referred to as "tubal pregnancy", and is thought to affect 2% of all pregnancies. An ectopic pregnancy means that the pregnancy has implanted and started to grow in a location other than the uterus. Most often this will occur in the fallopian tubes, but an ectopic pregnancy can also begin to grow into the ovaries, the cervix, or even the intestine - although this is very rare.

The Centers for Disease Control in Atlanta has reported significant increases in the number of ectopic pregnancies in the United States over the last 20 years. Currently there are approximately 100,000 ectopic pregnancies per year in this country. These account for 40 to 50 maternal deaths per year, or 15% of all maternal deaths, with an annual medical cost of over $1 billion.

There are numerous possible reasons for the increase of these abnormal pregnancies. These include an increased occurrence of female pelvic infections, more frequent use of female sterilization procedures (such as "tubal-ligation"), and the use of ovulation-inducing drugs for infertility. Women who have had a previous ectopic pregnancy are 13 times more likely to have another. Likewise, women who smoke are twice as likely to have an ectopic pregnancy as non-smokers.

The diagnosis of this condition is based on a combination of the patients symptoms, blood tests for a pregnancy hormone called "beta-hCG", and the use of ultrasound. Sometimes surgery is needed to help make the diagnosis, and this usually consists of a laparoscopy or "belly-button surgery".

Major advances have been made in the treatment of ectopic pregnancy. If the ectopic is detected early enough and if certain conditions are met, it can be treated with an injectable medication called methotrexate. This treatment has very good results, and very few side effects, but does require close follow-up with your doctor until all symptoms are gone. Frequently, the treatment of this condition requires surgery. But this can often be a conservative surgery that will spare the fallopian tube. After either of these treatments, once the fallopian tube heals it remains open and functional up to 80% of the time. In addition, about 60-80% of these women will go on to have a normal pregnancy.

In summary, although the rates of ectopic pregnancy have been increasing, effective treatments exist. If you have missed a period and experience pain with bleeding, it is important to report this to your doctor. Although these symptoms do not always mean that an ectopic pregnancy is present, if one is detected early enough it can sometimes be treated with methotrexate in order to avoid surgery.

Bibliography

1. Ectopic Pregnancy: Prompt diagnosis spells effective treatment; B Seeber, and K Barnhart; Contemporary OBGYN; Aug 2004

2. Novak’s Gynecology, Twelfth Edition, Jonathan S. Berek, M.D., Williams & Wilkins, Baltimore, 1996.

3. Ectopic Pregnancy, ACOG Technical Bulletin # 150, December 1990.

4. Precis - Gynecology, American College of Obstetricians and Gynecologists, 1998.