An ectopic pregnancy is a pregnancy where the fertilized egg settles and grows outside the inner lining of the uterus (not in the uterus). The uterus is the womb. Most ectopic pregnancies occur in the Fallopian tube known as a tubular pregnancy but they can also occur in the cervix (neck of the womb), abdominal cavity and ovary.

Slightly over 1% of all pregnancies are ectopic pregnancies. In a normal pregnancy the egg should be fertilized by the sperm in a fallopian tube; the fertilized egg then travels into the uterus (womb) and implants itself in the lining of the uterus. The embryo develops into a fetus and remains in the uterus until the baby is born.

An ectopic pregnancy that remains untreated may kill the mother. For example, the fallopian tube can rupture, causing internal abdominal bleeding and serious blood loss. These days, very few ectopic pregnancies result in death. Out of 31,000 ectopic pregnancies that occurred in the UK from 2000 to 2002, eleven women died, or 0.035% of the total (according to The National Health Service, UK).What are the signs and symptoms of an ectopic pregnancy?The initial signs and symptoms of an ectopic pregnancy are the same as any normal pregnancy, and includeMissing a menstrual periodFatigue (tiredness) NauseaBreast tendernessIf it is an ectopic pregnancy, the distinctive signs and symptoms will appear between weeks 4 and 10 of the pregnancy. Symptoms may includePain on one side of the abdomen. The pain may be severe and continuous.
Vaginal bleeding bleeding will be lighter or darker than menstrual bleeding, and is usually less viscous (more watery). In some cases a woman may not know she is pregnant and think her period has come.
Shoulder tip pain this is usually a sign that internal bleeding is occurring. Experts say the bleeding irritates the phrenic nerve, which causes referred pain in the shoulder. Referred pain is pain which exists in one part of the body but is felt by the patient in another part.
Pain when passing urine.
Pain when passing stools (feces).
Collapse if the fallopian tubes rupture the woman may collapse, due to serious internal bleeding. When the fallopian tubes rupture it is a medical emergency. The woman may

Feel light headedFeel faintFeel sickHave diarrheaFeel something is seriously wrongLook very paleOver half of all women with an ectopic pregnancy have no symptoms until they experience a collapse. Any woman who thinks she is pregnant again after previously having an ectopic pregnancy should tell her doctor immediately in order to find out whether the current pregnancy is ectopic.

In most cases fallopian tube rupture is successfully treated. It can be fatal, but this is very rare today if the patient receives treatment.What are the risk factors for ectopic pregnancy? A risk factor is something that increases your risk of developing a condition or disease. For example, smoking regularly significantly increases your risk of developing lung cancer; hence, smoking is a risk factor for lung cancer. The risk factors for ectopic pregnancy areHaving had an ectopic pregnancy before women who have had a prior ectopic pregnancy have a 10% risk of having a subsequent ectopic pregnancy.
Age while a 25yearold womans risk is 1%, a 44yearold woman who becomes pregnant has an 8% risk of having an ectopic pregnancy.
Salpingitis women who have had salpingitis (inflammation of the fallopian tube) have a higher risk of ectopic pregnancy.
Other infections infections of the uterus or ovaries (pelvic inflammatory disease, or PID) increase the risk of subsequent ectopic pregnancies. Some STDs, such as gonorrhea or Chlamydia, also increase the risk of PID.
Smoking women who smoke are more likely to have an ectopic pregnancy compared to women who dont.
Ovulation medications women with fertility problems who have been taking drugs to stimulate ovulation are more likely to have an ectopic pregnancy, compared to other women.
Fallopian tube abnormality a woman who has an abnormallyshaped fallopian tube, or a fallopian tube that has been damaged runs a higher risk of ectopic pregnancy. Fallopian tube damage may have been caused by surgery.
Previous surgery such as a Csection (Cesarean section) or surgical fibroid removal.
Taking contraceptive if a woman is taking the contraceptive pill or an IUD (intrauterine device) and gets pregnant she has a higher chance of having an ectopic pregnancy.
Tubal ligation in the unlikely event of becoming pregnant after a tubal ligation (having the tubes tied), there is a greater chance that that pregnancy is an ectopic one. 47% of women who have an ectopic pregnancy have none of the risk factors mentioned above.What causes an ectopic pregnancy? The fertilized egg becomes stuck on its way to the uterus. This usually occurs because the fallopian tube is scarred, has an abnormal shape or is damaged. In many cases nobody knows what the specific cause was.How is an ectopic pregnancy diagnosed? Blood test HCG (chorionic gonadotropin), a hormone, is produced in pregnancy and detected in a blood test women with a normal pregnancy will have high levels of HCG. If HCG levels are lower than normal for pregnancy, it could be a sign of an ectopic pregnancy.
Urine test a urine test can only tell whether an egg has been fertilized whether the woman is pregnant. It cannot distinguish between an ectopic or normal pregnancy.
Transvaginal ultrasound this is an ultrasound scan through the vagina and can sometimes confirm an ectopic pregnancy. Sound waves are emitted by an ultrasound probe that has been inserted in the vagina. The sound waves bounce off the vaginal wall and other tissue; a computer uses the ultrasound echoes to create a sonogram (a picture). If it is too early to detect an ectopic pregnancy and the diagnosis is doubtful, the doctor may monitor the patients condition with blood tests until the ectopic pregnancy can either be confirmed or ruled out through a subsequent ultrasound some time later.What are the treatment options for ectopic pregnancy? Several treatment options are possible if diagnosis is made before the fallopian tube ruptures.Surgery the embryo is surgically removed using laparoscopic (keyhole) surgery. The surgeon makes a small incision near or in the navel, inserts a thin tube with a camera and light at the end (laparoscope) to view the area. Other surgical instruments are inserted into a tube or through other small incisions to remove the ectopic tissue. If the fallopian tube is damaged it will either be removed or repaired.
Medication if the ectopic pregnancy is detected soon enough methotrexate is injected into the patients muscle or directly into the fallopian tube to halt cell growth and dissolve existing cells. The patient is then monitored for blood levels of HCG (chorionic gonadotropin). If blood HCG levels do not drop, the patient may receive another injection. This drug can cause abdominal pain as a side effect.
Wait and see if the symptoms are very mild the doctor may recommend waiting to see how things develop. Often, ectopic pregnancies terminate on their own. Ruptured fallopian tube if the fallopian tube ruptures (bursts) the patient will need emergency surgery. If possible the fallopian tube will be repaired, if not it will be removed.What are the possible complications of an ectopic pregnancy? A complication is more likely to occur if diagnosis or treatment is either delayed or never done. A woman who has an ectopic pregnancy and does not get timely diagnosis/treatment is more likely to experience severe internal bleeding, which can lead to shock. Shock in some cases can be fatal.

Delayed treatment can also result in damage to the fallopian tube; significantly raising the risk of further ectopic pregnancies in future.

There is also a risk of depression and sadness if the woman worries about the possibility of never being able to have a healthy pregnancy. It is important to remember that even if a fallopian tube is removed it is still possible to get pregnant. If both are removed IVF (invitro fertilization) is still an option.PreventionAlthough there is nothing a woman can do to prevent the occurrence of an ectopic pregnancy developing, she can reduce her risk of having a PID (pelvic inflammatory disease), which can damage the fallopian tubes. STIs (sexually transmitted infections), such as Chlamydia and gonorrhea are one of the main causes of PID. Therefore, “safe sex” using a male condom helps reduce the risk of catching an STI.

As smoking is known to increase the risk of having an ectopic pregnancy, giving it up would lower the risk.