It does not explain all of the proper treatments or methods of care. The definitive diagnosis of ectopic pregnancy can be made with ultrasound visualization of a yolk sac and/or embryo in the adnexa. Ectopic pregnancies happen when a fertilized egg implants somewhere outside of the uterus, like the fallopian tube or the cervix. You can detect hCG in either blood or urine . A complete blood count will be done to check for anemia or other signs of blood loss. This content does not have an English version. You'll need blood tests and an ultrasound. The clinical manifestations and diagnosis of ectopic pregnancy are reviewed here with a focus on tubal pregnancy. Pregnancy of unknown location can be diagnostically challenging because the increase in -hCG level can be similar among women with an early viable pregnancy, ectopic pregnancy, or early pregnancy loss.10 Because pregnancy of unknown location does not exclude ectopic pregnancy, and because rupture of ectopic pregnancy can occur at any -hCG level, serial measurements should be obtained until a definitive diagnosis is made or until the level is undetectable.16 Patients should be counseled about warning signs of ectopic pregnancy, including shoulder pain, pelvic pain, and dizziness. include protected health information. If you are a Mayo Clinic patient, this could The estimated mortality of ectopic pregnancy is between 2 and 4/1000. The rate of early pregnancy loss is approximately 11% after a live fetus has been detected on ultrasonography.17 The risk of early pregnancy loss is increased when subchorionic hemorrhage (Figure 36 ) and bleeding are present. Make a donation. Bleeding equal to or heavier than a menstrual period and bleeding accompanied by pain are associated with an increased risk of early pregnancy loss.2,7 Patients should be assessed for signs and symptoms of hypovolemia. HCG levels alone do not diagnose an ectopic pregnancy. There is no evidence that palpation during the pelvic examination leads to an increased risk of rupture.10, Beta human chorionic gonadotropin (-hCG) can be detected in pregnancy as early as eight days after ovulation.14 The rate of increase in -hCG levels, typically measured every 48 hours, can aid in distinguishing normal from abnormal early pregnancy. Pregnancy of unknown location describes the scenario in which a pregnancy test is positive, but neither intrauterine nor ectopic pregnancy is shown on ultrasonography. An ectopic pregnancy is a pregnancy that happens outside of your uterus. Several weeks of follow-up are required with each treatment. Hormone: A substance made in the body by cells or organs that controls the function of cells or organs. The discriminatory level varies with the type of ultrasound machine used, the sonographer, and the number of gestations. Approximately 25% of pregnant women experience bleeding before 12 weeks' gestation.1,2 The differential diagnosis includes nonobstetric causes, bleeding in a viable intrauterine pregnancy, early pregnancy loss, and ectopic pregnancy. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Guide to a Healthy Pregnancy, Book: Your Guide to Miscarriage and Pregnancy Loss. [2012] Declining or low rate of increase in hCG over 48 hours can be a sign of an ectopic pregnancy or miscarriage. hCG levels can help health care providers diagnose ectopic pregnancies, when interpreted together with ultrasound, and therefore help people get the care they need quickly. Another possibility is that you could be experiencing a miscarriage. In a salpingectomy, the ectopic pregnancy and the tube are both removed. In a patient with a -hCG value above this level, failure to visualize an intrauterine pregnancy strongly suggests ectopic pregnancy. If you do not have the symptoms of a fallopian tube rupture but your ob-gyn or other health care professional suspects you may have ectopic pregnancy, he or she may: Perform an ultrasound exam to see where the pregnancy is developing, Test your blood for a pregnancy hormone called human chorionic gonadotropin (hCG). There's some overlap between the possible trends in hCG levels for normal and ectopic pregnancies. 2019;74. doi:10.6061/clinics/2019/e1111. 5. A history of ectopic pregnancies or a history of surgery on the fallopian tubes are the factors that most increase the risk. If ectopic pregnancy has been diagnosed, the patient is deemed clinically stable, and the affected fallopian tube has not ruptured, treatment options include medical management with intramuscular methotrexate or surgical management with salpingostomy (removal of the ectopic pregnancy while leaving the fallopian tube in place) or salpingectomy (removal of part or all of the affected fallopian tube). Methotrexate can cause sun sensitivity. Have you taken a pregnancy test? Complications Is an Ectopic Pregnancy Dangerous? Risk factors include a history of pelvic inflammatory disease, cigarette smoking, fallopian tube surgery, previous ectopic pregnancy, and infertility. Ultrasound Transvaginal ultrasound A transvaginal ultrasound allows your doctor to see the exact location of your pregnancy. This can be done laparoscopically or through an abdominal incision (laparotomy). The fertilized egg travels through the fallopian tube and into the uterus, where it attaches to the uterine wall. Approximately one-fourth of pregnant women will experience bleeding in the first trimester. Pregnancy that develops outside the uterus is called ectopic pregnancy. If one is damaged or removed, an egg may join with a sperm in the other tube and then travel to the uterus. If both fallopian tubes have been injured or removed, in vitro fertilization (IVF) might still be an option. Skip to primary navigation . In these cases, the ectopic pregnancy can be removed from the tube, or the entire tube with the pregnancy can be removed. Copyright 2023 American College of Obstetricians and Gynecologists, Privacy Statement A review of the menstrual history and prior ultrasonography can help establish gestational dating and determine whether the pregnancy location is known. Mayo Clinic does not endorse companies or products. If you have sudden, severe pain; shoulder pain; or weakness, you should go to an emergency room. Typically, if you go to your health care provider with concerns like this, they will order an ultrasound. If the woman is less than 6 weeks pregnant and is bleeding but not in pain, consider expectant management. Management of these pregnancies has changed dramatically over the years. However, if a persons hCG level is rising slowly or decreasing, this suggests that the pregnancy may be ectopic. Blood tests and ultrasound testing can alert your doctor if another ectopic pregnancy is developing. Pregnancy FAQ 155. It can be helpful to jot down your questions for the doctor before your visit. Oral mifepristone (Mifeprex), 200 mg, followed 24 hours later by misoprostol, 800 mcg vaginally, is the most effective regimen for medical management of early pregnancy loss and, when available, should be recommended over misoprostol alone. Journal of Womens Health. 1. In some cases, the fallopian tube can be saved. The behavior of this hormone can help detect a dangerously abnormal pregnancy. This is why hCG levels alone aren . Ultrasound findings diagnostic of early pregnancy loss include a mean gestational sac diameter of 25 mm or greater with no embryo and no fetal cardiac activity when the crown-rump length is 7 mm or more. 2015;112(41). You may opt-out of email communications at any time by clicking on You may feel abdominal discomfort or pain. Most often this occurs in one of the fallopian tubes (called a tubal pregnancy) but it can also happen on the cervix or elsewhere in the abdominal region. ERIN HENDRIKS, MD, HONOR MACNAUGHTON, MD, AND MARICELA CASTILLO MACKENZIE, MD, Related letter: Progestin Therapy Not Likely to Be Harmful in Women with First Trimester Bleeding. This content is owned by the AAFP. It uses sound waves to create images of your uterus, ovaries and fallopian tubes, and sends the pictures to a nearby monitor. Abstract. Advertising revenue supports our not-for-profit mission. Confirming pregnancy . Ectopic pregnancy occurs when a fertilized ovum implants outside of the uterine cavity. Frequently asked questions. Most ectopic pregnancies are diagnosed between six and nine weeks of pregnancy. This combination should make an obstetrician-gynecologist consider the possibility of an ectopic pregnancy. Levels peaks during the first eight to 11 weeks of pregnancy, then decline and plateau. In 95% of ectopic pregnancy cases, a good transvaginal ultrasound examination can actually image the ectopic pregnancy in the Fallopian tube. Ectopic pregnancies and normal pregnancies require very different medical management. General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery. Mayo Clinic is a not-for-profit organization. As your pregnancy progresses, the hCG level increase slows down significantly. What are my chances of having a healthy pregnancy in the future? "hCG helps the body produce hormones to support pregnancy," explains John Zhang, M.D., founder. . In these procedure, a small incision is made in the abdomen, near or in the navel. Copyright 2023 American Academy of Family Physicians. A choice of either methotrexate or surgical management is offered to women with an ectopic pregnancy who have a serum hCG level of at least 1500 IU/L and less than 5000 IU/L, . It is safe to try to conceive again immediately; those who attempt to conceive within the first three months after early pregnancy loss have higher rates of pregnancy and live birth compared with those who wait longer.33,34 Although a Cochrane review found insufficient evidence that psychological support after pregnancy loss improves well-being, the decision to refer for counseling should be made on an individual basis.35, The incidence of ectopic pregnancy is 1% to 2% in the United States.36 Ruptured ectopic pregnancies account for 6% of all maternal deaths, with a higher rate in black patients.36 Risk factors include pelvic inflammatory disease, previous tubal surgery, previous ectopic pregnancy, and in utero exposure to diethylstilbestrol.37 Criteria for surgical, medical, or expectant management are described in Table 3.6,15,38,39, -hCG level < 1,000 mIU per mL and decreasing, Ectopic or adnexal mass < 3 cm or not detected, Patient reliable for follow-up and has no barriers to accessing health care, No medical contraindication (hematologic dysfunction; liver, kidney, or pulmonary disease; immunodeficiency; peptic ulcer disease; breastfeeding; sensitivity to methotrexate; alcohol abuse), Advanced ectopic pregnancy (high -hCG level, large mass, embryonic cardiac activity), Contraindications to observation or methotrexate, Patient unreliable for follow-up or has barriers to accessing health care (individualization of intervention), Unstable vital signs or signs of hemoperitoneum, Surgical management is indicated for patients with contraindications to medical treatment or failed medical treatment, and for patients who are hemodynamically unstable. 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