What is a tubal pregnancy?
An ectopic pregnancy, commonly known as a tubal pregnancy, is a pregnancy in which the fertilized egg implants itself somewhere other than the uterus. It is referred to as a tubal pregnancy because 95% of ectopic pregnancies occur when the fertilized egg is unable to travel all the way through the fallopian tube to the uterus, and therefore implants itself in the tube.

Of all ectopic pregnancies, 1.5% are abdominal, 0.5% are ovarian, and 0.03% are cervical. None of these places are suited for a growing baby. As the fetus grows, it can eventually burst the organ that contains it, causing severe internal bleeding, and endangering the mother's life. Unfortunately, a tubal pregnancy will never develop into a live birth.

Although there have been advances in surgical technology that have caused the death rate due to tubal pregnancy to drop since 1970, there is still a death rate of about 1 out of 2000, with about 40-50 women dying each year in the U.S.

What causes tubal pregnancy?
There are many reasons why an egg may become lodged in the fallopian tube. It is most often caused by an infection or inflammation of the tube that partially or entirely blocks the passage. Pelvic inflammatory disease (PID) is the most common of these infections.

Endometriosis, when cells from the lining of the uterus detach and grow elsewhere in the body, can cause blockages. Scar tissue from previous pelvic or fallopian surgery can also lead to tubal pregnancy. Less frequently, abnormal growths or birth defects can alter the shape of the tube and obstruct the egg's progress.

How will I know if I am having a tubal pregnancy?
It can be difficult to recognize symptoms of tubal pregnancy since many of the early signs mirror those of a normal pregnancy, such as missed periods, breast tenderness, nausea, vomiting, or frequent urination.

Some of the symptoms more specific to tubal pregnancy are:

• Pain in your lower belly
• Slight bleeding from vagina
• One-sided pain in your stomach
• Shoulder pain (which may be caused by internal bleeding irritating your diaphragm when you breathe)
• Bladder or bowel problems
• Feeling light-headed or faint, sometimes accompanied by paleness, increased pulse, diarrhea, and falling blood pressure (caused by blood loss)
• Abnormal bleeding (heavier or lighter than usual and prolonged, or dark and watery, almost like prune juice)
• Lower back pain

If you experience any of these symptoms you should go directly to the emergency room. If you arrive at the hospital complaining about abdominal pains, you will most likely be given a pregnancy test. Urine pregnancy tests are not necessarily the best pregnancy tests, but they are fast. Speed can be crucial in dealing with a tubal pregnancy.

If the pregnancy test comes back positive then your doctor will probably perform a quantitative hCG test to measure the amount of human chorionic gonadotropin in your body. hCG is a hormone produced by the placenta which shows up in the blood and urine as early as 10 days after conception. Its levels double every day for the first 10 weeks of pregnancy. Lower-than-expected hCG levels could indicate a tubal pregnancy.

You will be given a pelvic exam as well, to find the areas causing pain, check for an enlarged, pregnant uterus, or locate any masses in your abdomen. The doctors will probably also perform an ultrasound examination, which would show if the uterus contained a developing fetus or determine whether there are masses growing elsewhere in the abdomen. Unfortunately, the ultrasound may not be able to detect every tubal pregnancy.

There is also a more rarely used test for tubal pregnancy, called culdocentesis, which is used to check for internal bleeding. This test is performed by inserting a needle into the space at the very top of the vagina, behind the uterus and in front of the rectum. If there is blood or fluid found there, it most likely comes from a ruptured tubal pregnancy.

What can be done about my tubal pregnancy?
Treatment for a tubal pregnancy will depend on its size and location, and on whether or not you would like the ability to conceive again.

If caught early enough, a tubal pregnancy may be able to be treated with an injection of methotrexate, which would dissolve the fertilized egg and allow it to be reabsorbed into the body. This non-surgical approach results in minimal scarring of the pelvic organs.

A tubal pregnancy that is further along will likely require surgery to be removed. In the past, this operation would have required a very large incision across the lower abdomen, which may still be necessary in cases of emergency or severe internal injury.

However, modern technology has bestowed upon us an alternative method of removal. In many cases, the tubal pregnancy can be removed using laparoscopy, a much less invasive surgical procedure. The surgeon makes a small incision in the lower abdomen and inserts a laparoscope, a long, hollow tube with a lighted end. This allows the surgeon to see internal organs and insert other instruments as need. The tubal pregnancy is then removed, and the damaged organs are repaired or removed.

Regardless of which procedure is used, the doctor will want to continue seeing you regularly, to monitor your hCG levels, which should return to zero. This may take up to twelve weeks, but if the hCG levels do not decline, it could mean that some of the ectopic tissue was missed and may need to be removed using methotrexate or additional surgery.

How will this affect my future pregnancies?
About a third of women with a previous tubal pregnancy will have trouble conceiving again. This depends mainly on the total amount of damage and surgery that was done.

If the fallopian tubes remain intact, chances for a successful pregnancy in the future are about 60%. Even with only one fallopian tube, chances can be greater than 40%.

The risk of a repeat tubal pregnancy is increased with each subsequent tubal pregnancy. After your first one, you face about a 15% chance of having another.

Am I at risk of having a tubal pregnancy?
Those most at risk of having a tubal pregnancy are women between the ages of 35 and 45 who have had a PID, a previous tubal pregnancy, surgery on a fallopian tube, or infertility problems or medication to stimulate ovulation.

Some birth control methods may also increase your chances for a tubal pregnancy. If you become pregnant while using progesterone intrauterine devices (IUDs), progesterone-only oral contraceptives, or the morning after pill, you may be more likely to have a tubal pregnancy.

If you think that you may be at risk of tubal pregnancy, talk to your doctor about it before attempting to conceive. Although there is nothing that can be done to prevent tubal pregnancy, if monitored closely it can be detected early.

If you are pregnant and experience any of the symptoms of tubal pregnancy, contact your doctor immediately. Tubal pregnancy is just one of those things that you want to have checked out, even if you only have so much as a hunch. It can't hurt to be sure, and it may save your life.