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Family Birthing and Maternity Services, St. Vincent's Medical Center, Bridgeport CT

Ectopic Pregnancy - 
Causes, Incidence & Risk Factors

St. Vincent's Medical Center, Bridgeport CTAn ectopic pregnancy is an abnormal pregnancy that occurs outside the womb (uterus). The baby (fetus) cannot survive, and often does not develop at all in this type of pregnancy.

An ectopic pregnancy occurs when a pregnancy starts outside the womb (uterus). The most common site for an ectopic pregnancy is within one of the tubes through which the egg passes from the ovary to the uterus (fallopian tube). However, in rare cases, ectopic pregnancies can occur in the ovary, stomach area or cervix.

Causes

An ectopic pregnancy is often caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube by hormonal factors and by other factors, such as smoking.

Most cases of scarring are caused by:

  • Past ectopic pregnancy
  • Past infection in the fallopian tubes
  • Surgery of the fallopian tubes

Some ectopic pregnancies can be due to:

  • Birth defects of the fallopian tubes
  • Complications of a ruptured appendix
  • Endometriosis
  • Scarring caused by previous pelvic surgery

The following may also increase the risk of ectopic pregnancy:

  • Age over 35
  • Having had many sexual partners
  • In vitro fertilization

Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). Ectopic pregnancies are more likely to occur two or more years after the procedure, rather than immediately following. In the first year after sterilization, only about 6 percent of pregnancies will be ectopic, but most pregnancies that occur two - three years after tubal sterilization will be ectopic.

Ectopic pregnancy is also more likely in women who have:

  • Had surgery to reverse tubal sterilization in order to become pregnant
  • Had an intrauterine device (IUD) and became pregnant (very unlikely when IUDs are in place)

Ectopic pregnancies occur in one in every 40 to one in every 100 pregnancies.

Symptoms

  • Abnormal vaginal bleeding
  • Amenorrhea – having missed 3 or more periods in a row
  • Breast tenderness
  • Low back pain
  • Mild cramping on one side of the pelvis
  • Nausea
  • Pain in the lower abdomen or pelvic area

If the area of the abnormal pregnancy ruptures and bleeds, symptoms may get worse.

Severe symptoms of an ectopic pregnancy may include:

  • Feeling faint or actually fainting
  • Intense pressure in the rectum
  • Pain that is felt in the shoulder area
  • Severe, sharp and sudden pain in the lower abdomen

Internal bleeding due to a rupture may lead to low blood pressure and fainting in around 1 out of 10 women.

Signs and tests

Your healthcare provider will do a pelvic exam, which may show tenderness in the pelvic area. Several test can be done to confirm diagnosis.

A rise in quantitative HCG levels may help tell a normal (intrauterine) pregnancy from an ectopic pregnancy. Women with high levels should have a vaginal ultrasound to identify a normal pregnancy.

Treatment

Ectopic pregnancies cannot continue to birth (term). The developing cells must be removed to save the mother's life. St. Vincent’s physicians can treat ectopic pregnancies both surgically and non-surgically. 

You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to shock, an emergency condition. 

If there is a rupture, surgery (laparotomy) is done to stop blood loss. This surgery is also done to:

  • Confirm an ectopic pregnancy
  • Remove the abnormal pregnancy
  • Repair any tissue damage

In some cases, the doctor may have to remove the fallopian tube.

A minilaparotomy and laparoscopy are the most common surgical treatments for an ectopic pregnancy that has not ruptured. If the doctor does not think a rupture will occur, you may be given a medicine called methotrexate and monitored. You may have blood tests and liver function tests.

Contact us

To find a St. Vincent’s physician who can discuss your health concerns or those of a loved one, please click on our FIND A DOCTOR tool and search by specialty, practice, location or keyword. We’re here to help you locate the medical expert you need.

To speak with a St. Vincent's Care Line representative, call (877) 255-7847

To speak with somone at the front desk of the Medical Center, please call (203) 576-6000

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