How many ectopic pregnancies are there

This is partly because the underlying problem that caused the first ectopic pregnancy may still be there and also because the ectopic may have damaged or scarred the fallopian tube, or the tube may have been removed in surgical treatment. Both ectopic pregnancy and its causes may affect fertility. Your doctor will give you the best information about your individual circumstances. For medical reasons we usually recommend waiting two months after surgery and three to four months after medication before getting pregnant again.

Because it is possible to become pregnant again straight away, you will need to use contraception. We advise all women wanting to conceive to take folate tablets one month before getting pregnant and for three months into the pregnancy. It is recommended that anyone who has had an ectopic pregnancy has an early ultrasound examination, at around five and a half to six weeks in all future pregnancies to check that the pregnancy is in the right place.

After an ectopic pregnancy, as with a miscarriage , you may have mixed feelings about becoming pregnant again. You may find it useful to speak about your concerns with your GP or a counsellor. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.

Bleeding in early pregnancy Miscarriage Treating miscarriage Ectopic pregnancy Hydatidiform mole Section menu. On this page: What is an ectopic pregnancy? How is an ectopic pregnancy treated? Surgery Medication Wait and see What does this mean for future pregnancies? What is an ectopic pregnancy? Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change.

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Go to whole of WA Government Search. Open search bar Open navigation Submit search. Health conditions. Facebook Youtube Twitter. Home Health conditions Ectopic pregnancy. Ectopic pregnancy What is an ectopic pregnancy? An ectopic pregnancy occurs when a fertilised egg implants outside the uterus womb. Cause of ectopic pregnancies There are several conditions that can cause an ectopic pregnancy. Who is most at risk? Other risk factors include: using an intra-uterine device IUD , also known as a coil using a progesterone-only oral contraceptive pill minipill undergoing fertility treatment IVF.

In some cases the cause of an ectopic pregnancy may never be known. Possible outcomes In many cases of ectopic pregnancy, the fertilised egg dies quickly and is broken down by your system before you miss your period or after you experience some slight pain and bleeding.

Signs and symptoms Women who experience an ectopic pregnancy have all the signs of a normal pregnancy, in the beginning. These include: vaginal bleeding lower left or right side abdominal stomach pain feeling light-headed or faint. Managing an ectopic pregnancy If an ectopic pregnancy is suspected, your doctor will perform an ultrasound scan and a pregnancy test. Treatment of ectopic pregnancy Currently there are 3 different treatments available for an ectopic pregnancy.

Laparoscopic keyhole surgery to remove fertilised egg from fallopian tubes A telescopic device the laparoscope is inserted through a small cut below your navel belly button. Laparotomy to remove the ectopic pregnancy If the pregnancy is advanced or there has been significant associated haemorrhaging bleeding then your doctor may perform a laparotomy, a type of surgery involving a much larger incision.

Intramuscular injection of the drug methotrexate A medication called methotrexate is used to dissolve the pregnancy tissue. Washington, D.

Cigarette smoking as a risk factor for ectopic pregnancy. Abdominal pregnancy. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. Diagnosis and treatment of tubal pregnancy as related to risk determinants. Is maternal serum creatinine kinase actually a marker for early diagnosis of ectopic pregnancy?

Clinical value of creatinine kinase in the diagnosis of ectopic pregnancy. Gynecol Obstet Invest. Fetal fibronectin as a marker to discriminate between ectopic and intrauterine pregnancies.

First-trimester rapid semiquantitative assay for urine pregnanediol glucuronide predicts gestational outcome with the same diagnostic accuracy as serial human chorionic gonadotropin measurements. Serum progesterone and endovaginal sonography by emergency physicians in the evaluation of ectopic pregnancy. Acad Emerg Med. Single serum progesterone as a screen for ectopic pregnancy: exchanging specificity and sensitivity to obtain optimal test performance. Fertil Steril.

Early screening for ectopic pregnancy in high-risk symptom-free women. Transvaginal sonography in the management of ectopic pregnancy. Emergency department screening for ectopic pregnancy: a prospective US study.

Suspected ectopic pregnancy. What to do when human chorionic gonadotropin levels are below the discriminatory zone. J Reprod Med. A study of risk factors for ruptured tubal ectopic pregnancy. J Womens Health. Successful treatment of a heterotopic pregnancy by sonographically guided instillation of hyperosmolar glucose. Combined chemotherapy in the medical management of tubal pregnancy. Identification of hormonal parameters for successful systemic single-dose methotrexate therapy in ectopic pregnancy.

Hum Reprod. Randomised trial of systemic methotrexate versus laparoscopic salpingostomy in tubal pregnancy.

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J Am Board Fam Pract. Rudy, M. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.

Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Somatizing Patients: Part I. Practical Diagnosis. Feb 15, Issue. Ectopic Pregnancy. Risk Factors for Ectopic Pregnancy Strong evidence for association Pelvic inflammatory disease Previous ectopic pregnancy Endometriosis Previous tubal surgery Previous pelvic surgery Infertility and infertility treatments Uterotubal anomalies History of in utero exposure to diethylstilbestrol Cigarette smoking Weaker evidence for association Multiple sexual partners Early age at first intercourse Vaginal douching.

TABLE 1. Ectopic pregnancy identified at laparoscopy. TABLE 2. Criteria for the Use of Methotrexate Rheumatrex in Patients with Ectopic Pregnancy The rightsholder did not grant rights to reproduce this item in electronic media. Ectopic mass removed from the fallopian tube by linear salpingostomy. Read the full article. Get immediate access, anytime, anywhere. Often, laparoscopy is required for diagnosis, at which point definitive surgical management is often completed [ ].

Management of ovarian EPs is primary surgical, and laparoscopic surgery has become the standard for management of hemodynamically stable patients with ovarian EPs [ , ]. Resection of the EP and retention of the ovary is a reasonable surgical objective, particularly in patients desiring future fertility.

This resection has most commonly taken the form of an ovarian wedge resection, attempting to remove as little normal ovarian tissue as possible [ ]. In reports of surgical management of ovarian ectopic, hemostasis is obtained with electrocautery or ultrasonic energy; the latter is less damaging to the surrounding ovarian cortex [ , ].

Management of cervical pregnancies may be medical or surgical, with many centers utilizing a combination of approaches.

In a review of 52 cervical EPs, Dilation and curettage is seldom used in isolation as a first line treatment, given the risk of hemorrhage; in a review of 15 cases with mean gestational age of 8. Methods for decreasing the risk of bleeding include injection of vasoconstricting agents into the cervix, such as dilute vasopressin, or placement of cervical stay sutures [ ].

Placement of intracervical catheter for tamponade, such as a 30 mL foley catheter, has also been described [ ]. In the presence of fetal cardiac activity, preoperative injection of feticides may decrease the risk of hemorrhage [ ]. This therapy is not currently recommended for women who wish to conceive in the future, as its ramifications for fertility have not been conclusively described. Interruption of a cesarean scar EP upon diagnosis is recommended, given the risk of hemorrhage, hysterectomy and maternal morbidity [ , ].

Live births resulting from a cesarean scar ectopic implantation have been described; however, these deliveries are frequently associated with hemorrhage and emergent cesarean hysterectomy [ 9 , , ]. Medical management with single or multiple dose systemic MTX regimens has been described. Initial steps for managing hemorrhage include tamponade with a transcervical catheter and hemostatic cervical cerclage sutures [ ].

UAE has been used as both hemorrhage prophylaxis and salvage therapy in the event of hemorrhage [ ]. UAE is not currently recommended for patients desiring future fertility. Hysteroscopic resection is not recommended when the residual myometrium is less than 3 mm, given the risk of anterior wall perforation and bladder injury [ , ]. Transabdominal excision of these lesions has been described by laparotomy, and standard or robotic-assisted laparoscopy [ ].

Resection also allows for revision of the lower uterine segment, which theoretically may reduce risk for recurrence [ ]. Laparotomy may be indicated in patients with suspected uterine rupture and hemodynamic instability, and hysterectomy may be required for otherwise uncontrollable hemorrhage [ ].

Of note, complications of medical or surgical management include formation of arterio-venous malformations, which are prone to bleeding; in one series of 60 cesarean scar EPs, this occurred at a rate of 8. Left uterine artery arterio-venous malformation AVM by pelvic angiogram.

The AVM was embolized with coils, but the patient required emergent hysterectomy for hemorrhage. In patients who are hemodynamically stable without evidence of rupture of the interstitial EP, non-surgical management may be appropriate. UAE has also been successfully used as an adjunct to these therapies [ , ]. Laparotomy and hysterectomy were formerly first line treatment, likely due to late diagnosis of interstitial pregnancies and higher rates of rupture and hemorrhage.

These methods may still be necessary in patients with hemodynamic instability and severe hemorrhage. Minimally invasive surgeries are increasingly pursued as imaging modalities allow for earlier diagnosis. Small case series have described ultrasound or laparoscopy-guided dilation and curettage [ — ].

Several laparoscopic surgical approaches have been described, including cornuostomy, salpingostomy, and cornual resection. Case series have also described successful surgical management with placement of an Endoloop around the base of the cornua before or after excision for both hemostasis and closure [ ]. Less commonly, salpingostomy for interstitial ectopic has been reported, which is most appropriate for interstitial EP less than 3.

Cornual resection has been recommended for surgical management of more advanced interstitial pregnancies greater than 3—4 cm [ 12 , ]. This technique entails injection of dilute vasopressin followed by a circumferential incision using scissors or an energy source—electrosurgical or ultrasonic—preferably 1—2 cm above the cornual pregnancy to allow for redundant serosa and myometrium for closure [ 11 , 12 ].

This incision should be closed in layers akin to a myomectomy closure. The fallopian tube adjacent to this cornua should also be excised. UAE has also been used as a prophylactic measure before laparoscopic cornual resection [ ]. In clinically stable patients with intramural EPs diagnosed by imaging, medical management is an option. Most cases of intramural EP reported in the literature have been managed surgically via laparotomy, sometimes requiring hysterectomy, as many patients present with rupture of the EP and hemorrhage [ 13 ].

Given the increasing ability of noninvasive imaging to diagnose intramural EPs and the advancement of minimally invasive surgery, more recent case reports have described laparoscopic excision of intramural ectopic gestations [ , ]. Intervention for resolution of an abdominal EP is recommended upon diagnosis, given the extremely high risk for maternal morbidity; the mortality risk associated with abdominal EPs is nearly 8 times the rate with tubal EPs [ 16 ].

Rare reports detail expectant management in order to attain a live birth. Expectant management of abdominal EPs may potentially be considered when the diagnosis is made after 20 weeks of gestation in a healthy patient who can be followed very closely through a tertiary care center.

The fetus should have no congenital malformations, and the placenta should be implanted away from the upper abdomen. Delivery is recommended at 34 weeks, and the placenta is often left in place given the risk for hemorrhage [ , ].

Abdominal EPs have been approached by laparoscopy or laparotomy, with or without prophylactic embolization of the placental bed; more recent cases in the literature have been managed laparoscopically in hemodynamically stable patients [ — ]. When abdominal EPs are removed surgically at any gestational age—though more commonly after 20 weeks of gestation—the placenta can be left in place to avoid hemorrhage [ 16 ].

The most common complication of an intraabdominal retained placenta is infection [ 16 ]. As diagnostic modalities have advanced and these pregnancies are diagnosed earlier, case reports of medical management for abdominal EP have been published.

Despite logistic regression, a meta-analysis failed to identify risk factors for failed medical management [ 16 ]. Medical management of tubal HPs includes local injections of KCl or a hyperosmolar glucose solution, though over half of tubal HPs managed with local KCl may require subsequent salpingectomy [ 17 , ]. Surgical management has been described more frequently, as patients with tubal HPs present more often with rupture and hemodynamic compromise than those with tubal EPs [ ].

Salpingectomy is preferable to salpingostomy as persistent trophoblastic tissue cannot be monitored in the setting of ongoing IUP [ 78 ]. For the management of interstitial HPs, expectant management, aspiration or injection of hyperosmolar glucose of the interstitial HP, and cornual resections have been reported, leading to live birth [ — ].

One patient attempting expectant management required a laparotomy for rupture of the interstitial EP [ ]. Hysteroscopy carries the theoretical risk of disrupting an IUP due to the high pressure infusion of fluid.

Cervical HPs addressed with expectant management, local KCl or hyperosmolar glucose injections, extraction with forceps, suction curettage or hysteroscopic resection, with or without subsequent foley tamponade, have resulted in live birth.

Rare case reports also detail cerclage placement following intervention. Abdominal HPs are rarely encountered, though live birth after local injection of KCl into the abdominal pregnancy has been reported in 3 cases [ ]. Ovarian HPs are similarly rare; live birth after local hyperosmolar glucose injection has been reported, as well as after laparoscopic wedge resection; surgical intervention carries the theoretical risk of interrupting hormonal support of the coexisting IUP by the corpus luteum [ , ].

The risk of recurrent EP is not affected by treatment modality—medical or surgical—or surgical procedure [ 38 ]. A review of 53 cases of prior interstitial EP reported a recurrence rate of 9. In patients with a prior interstitial EP, data is limited regarding the risk of uterine rupture in a subsequent IUP, though uterine rupture has been reported after both expectant management and cornual resection [ , ].

Vaginal deliveries have been reported following cornuostomy or cornual resection; the optimal mode of delivery in this group remains to be determined [ 12 ]. The risk of recurrent cervical EP appears to be low: One recurrence was noted in a series of 34 pregnant women with prior cervical EP treated with several different modalities [ 67 ].

The data are insufficient to comment on subsequent IUP and recurrence rates in patients with prior ovarian, intramural or abdominal EPs. Rates of recurrence and IUP after HP have not been extensively reported in the literature, and likely depend on the location of the HP and the treatment modality. Regardless of ectopic location, conception is not recommended for 3 months after exposure to MTX, though data for this recommendation is lacking [ 6 ]. Results of population-based studies of pregnancy outcomes after a prior tubal EP are encouraging, and independent of treatment modality.

The rates of IUP have been shown to be similar following salpingectomy and salpingostomy in several large series [ 39 , 40 ]. Ectopic pregnancy is a relatively common clinical scenario in general gynecology and reproductive medicine.

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