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Ectopic Pregnancy

An ectopic pregnancy is a pregnancy which occurs where it should not.  The most common location is within the fallopian tube, but ectopic pregnancies have been reported on the ovary, on the bowel, and even on the aorta!  Unfortunately, an ectopic pregnancy cannot be replaced into the correct location (the uterus), and thus it must be treated appropriately to avoid potentially serious harm to the patient.

Sometimes ectopic pregnancies can be definitely diagnosed by ultrasound.  Many times, however, the diagnosis of an ectopic pregnancy may not be definitive – but there may be enough concern based on ultrasound, bloodwork, and patient symptoms that a patient will still be treated for a presumptive ectopic pregnancy.

 If an ectopic pregnancy is caught early, medication (i.e. methotrexate) may be given to resolve the pregnancy.  Methotrexate is given as an intramuscular injection by a nurse.  Though 1 dose is frequently enough, sometimes a 2nd dose may be required.  The medication can cause gastrointestinal symptoms (i.e. pain, nausea, vomiting, and diarrhea).  Also, monitoring of bloodwork is still necessary to make sure that the ectopic pregnancy is treated appropriately.  The earlier the ectopic is discovered or presumed, the greater the likelihood of success using medical treatment. 

If the ectopic pregnancy is caught later, if the methotrexate has been given and has not worked, or if the patient prefers, a surgery can be performed to remove the ectopic pregnancy from the fallopian tube.  Sometimes the fallopian tube may need to be removed with the ectopic pregnancy, and other times the ectopic may be removed by itself, leaving the fallopian tube in place. Typically, this is done via a laparoscopy, though occasionally a larger incision may be required if the patient is having serious internal bleeding. 

The risk of a future ectopic pregnancy is generally increased in someone who has already experienced an ectopic pregnancy.  Your provider can give you a better estimate of risk in your particular scenario.  In the worst case scenario, ectopic pregnancy can cause severe blood loss and even death.  However, because of the early pregnancy monitoring which is available these days – and with the advancement of medicine and surgery – this is a rare outcome in this day and age.

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