About Ectopic Pregnancy

95% are in the Fallopian tube – either ampullary (in the middle part of the Fallopian tube), isthmic (in the upper part of the Fallopian tube close to the uterus) or fimbrial (at the end of the tube) 3% are interstitial (inside the part of the Fallopian tube that crosses into the uterus)

What is an Ectopic Pregnancy?

An ectopic pregnancy is a pregnancy that happens outside of your uterus. This occurs when a fertilized egg implants in a location that can’t support its growth. An ectopic pregnancy most often happens in your fallopian tube (a structure that connects your ovaries and uterus). Ectopic pregnancies more rarely can occur in your ovary, abdominal cavity or cervix. Pregnancies can’t continue if they’re ectopic because only your uterus is meant to carry a pregnancy.

Ectopic pregnancies can become life-threatening, especially if your fallopian tube breaks (ruptures). This is a ruptured ectopic pregnancy, and it can cause severe bleeding, infection and sometimes, death. This is a medical emergency. Healthcare providers must treat ectopic pregnancies quickly.

Signs and Symptoms of Ectopic Pregnancy

The early symptoms of an ectopic pregnancy can be very similar to typical pregnancy symptoms. However, you may experience additional symptoms during an ectopic pregnancy, including:

• Vaginal bleeding.
• Pain in your lower abdomen, pelvis and lower back.
• Dizziness or weakness.

If your fallopian tube ruptures, the pain and bleeding could be severe enough to cause additional symptoms. These can include:

• Fainting.
• Low blood pressure (hypotension).
• Shoulder pain.
• Rectal pressure or bowel problems.

When a tube bursts, you may feel sudden, sharp lower abdominal pain. This is a medical emergency. You should contact your healthcare provider or go to the emergency room immediately.

Causes of Ectopic Pregnancy

In most cases, conditions that slow down or block the movement of the egg down your fallopian tube cause ectopic pregnancy. This could happen because:

• You have scar tissue, adhesions or inflammation from a prior pelvic surgery.
• Your fallopian tubes have damage, such as from a sexually transmitted infection (STI).
• You were born with an irregularly-shaped fallopian tube.
• You have a growth blocking your fallopian tube.

Ectopic Pregnancy Risk Factors:

Here are the key risk factors that increase the chances of an ectopic pregnancy:

• Previous ectopic pregnancy
• Pelvic inflammatory disease (PID) or sexually transmitted infections like chlamydia or gonorrhea
• Previous pelvic or abdominal surgery (especially on fallopian tubes)
• History of infertility or fertility treatments (e.g., IVF)
• Smoking cigarettes
• Use of intrauterine devices (IUDs) or tubal sterilization procedures
• Maternal age above 35 years
• Endometriosis

Ectopic Pregnancy Complications 

An ectopic pregnancy is a medical emergency. Your uterus is the only organ that can hold a growing fetus. It can stretch and expand as the fetus grows. Your fallopian tubes aren’t as flexible. They can burst as the fertilized egg develops. If this happens, it can cause severe, life-threatening internal bleeding. This is dangerous. An ectopic pregnancy needs to be treated right away to avoid injury to your fallopian tube and other organs, internal bleeding and possibly, death.

Diagnosis of Ectopic Pregnancy

• Pelvic Exam: A physical pelvic examination may reveal tenderness, especially on one side of the lower abdomen, or an adnexal mass (a lump near the ovary or fallopian tube). While not definitive, these findings can raise suspicion for an ectopic pregnancy.
• Ultrasound: A transvaginal ultrasound is the key imaging test. In ectopic pregnancy, it typically shows no intrauterine pregnancy even when hCG levels are high enough for one to be seen. It may also detect an adnexal mass, a gestational sac outside the uterus, or free fluid in the pelvis, which could suggest bleeding.
• hCG Monitoring: Human chorionic gonadotropin (hCG) is a hormone produced in early pregnancy. In a normal pregnancy, hCG levels rise steadily. In ectopic cases, levels may be lower than expected or fail to double every 48–72 hours, which is a red flag.
• Laparoscopy: Considered the gold standard for diagnosis, laparoscopy is a minimally invasive surgical procedure that allows direct visualization of the pelvic organs. It confirms the presence of an ectopic pregnancy and can often treat it at the same time.

Ectopic Pregnancy Treatment

      Medication management

• Methotrexate: Stops cell growth in unruptured ectopic pregnancies (hCG <5,000 mIU/mL).

Note: Medication is only advisable under doctor's consideration.

Minimal Invasive Management:

• 3D Laparoscopic Salpingectomy : This procedure involves the removal of the fallopian tube that contains the ectopic pregnancy. It is often recommended when the tube is badly damaged or ruptured, or if the patient doesn’t plan future pregnancies. Using 3D laparoscopic technology, the surgeon gains enhanced depth perception and precision, allowing for safer, cleaner dissection with minimal trauma to surrounding tissues. It offers faster recovery, smaller scars, and less postoperative pain compared to open surgery.
• 3D Laparoscopic Salpingostomy : Salpingostomy is a fertility-sparing procedure where only the ectopic pregnancy is removed, while the fallopian tube is preserved. This is typically done when the tube is unruptured and the woman wishes to conceive in the future. The surgeon creates a small incision in the tube to remove the pregnancy tissue, then leaves the incision to heal naturally. With 3D laparoscopy, the procedure is more precise and less invasive, reducing the risk of complications and preserving reproductive potential.
• 3D Laparoscopic Removal of Ectopic Pregnancy : This refers broadly to the minimally invasive surgical removal of an ectopic pregnancy from locations like the fallopian tube, ovary, or abdominal cavity. The 3D visualization technology allows surgeons to carefully locate and extract the ectopic tissue while minimizing blood loss and damage to surrounding organs. It is especially useful in complex or early-diagnosed cases, helping ensure quicker healing, shorter hospital stays, and better cosmetic results.