Ectopic pregnancy

Although the incidence of ectopic pregnancy has increased during the past 30 years, early diagnosis and treatment have reduced the death rate by 90 percent. The development of sensitive urine and blood pregnancy tests, along with vaginal ultrasound, result in early diagnosis. Despite improved diagnostic methods, however, ectopic pregnancy remains the leading cause of pregnancy-related death (3.8 deaths per 10,000 cases) during the first 12 weeks of pregnancy and accounts for about 10 percent of all pregnancy related deaths.

Ectopic pregnancy occurs when the embryo implants at a site other than the lining of the uterus. Approximately 98 percent of ectopic pregnancies occur in the fallopian tube and the remainder are in the ovary, abdominal cavity or cervix.

Within six to eight weeks of a missed or abnormal period, symptoms of an ectopic pregnancy can include vaginal bleeding, abdominal pain, dizziness and feeling faint. Fifty percent of women with an ectopic pregnancy, however, have no complaints before tubal rupture and internal bleeding and do not have any identifiable risk factors. Treatment may be surgical, medical or, in rare cases, close observation. Women who are diagnosed early, without symptoms and have weekly monitoring are treated medically.

The most common risk factor is prior pelvic inflammatory disease. Other high risk factors are previous ectopic pregnancy and tubal surgery. Infertility and multiple sexual partners are moderate risk factors.

Contrary to what many people may think, the use of intrauterine devices (and other contraceptive devices and the pill) does not lead to an increased risk of ectopic pregnancy. In fact, the ectopic rates of women using ParaGard or Mirena IUDs are one-tenth the rate of women not using any contraception.

However, women using IUDs who develop symptoms of pregnancy must consult their gynecologist immediately because one-fifth of all IUD failures will result in an ectopic pregnancy.

Complications of ectopic pregnancy can be minimized if women with symptoms or risk factors see their gynecologist within two weeks of a missed or abnormal period.

Earlando Thomas, M.D., is a member of the Royal College of Obstetricians and Gynaecologists (MRCOG) and attending physician in the department of obstetrics and gynecology at Rochester General Hospital with an office on Portland Avenue.