The term “ectopic” indicates a normal occurrence is occurring at an abnormal site/location. Ectopic gestation refers to a pregnancy in which the conceptus implants at a site outside its normal site in the uterine cavity. It is commonly noticed in the first trimester.

Common sites of ectopic pregnancies include the Fallopian tubes, the ovaries, and the abdominal cavity. Over 95% of cases occur in the Fallopian tubes. Ectopic pregnancies usually rupture in the first trimester or a few weeks into the second trimester.

Risk factors include increasing maternal age, previous pelvic inflammatory disease, previous pelvic surgery, and previous history of ectopic gestation. Amongst contraceptives, intrauterine devices are most likely to lead to an ectopic pregnancy.

There are no findings on clinical examination that are diagnostic of a developing ectopic pregnancy. Vaginal bleeding and lower abdominal/pelvic pain are the most common symptoms. In most cases, the bleeding comes after the pain, unlike in miscarriages where the bleeding usually comes before the pain. In some cases, the ectopic pregnancy ruptures leading to massive internal bleeding and death if not managed quickly and effectively.

Diagnosis of ectopic pregnancy usually requires a combination of human chorionic gonadotrophin (hCG) assay with a transvaginal ultrasound. At hCG levels above 1000IU/L, a gestational sac should be present in the uterus, and if it is not seen on a transvaginal ultrasound scan, the pregnancy is most likely ectopic. In some cases of ectopic pregnancy, there is a pseudosac (‘false sac’) in the uterus (similar to a gestational sac but devoid of a developing foetus). However, the best method for diagnosing ectopic pregnancy is laparoscopy which involves directly viewing the abdominopelvic organs via an instrument passed into the abdominal cavity.

The classical treatment for ectopic pregnancy is tubal surgery with removal of the ectopic pregnancy. If noticed early enough, it can be treated medically with injections, and this is why women are encouraged to have an ultrasound scan done as soon as they suspect pregnancy. In some cases, ectopic gestations may regress on their own but such cases require close monitoring and follow-up.

 

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