Ectopic pregnancy

What it is

Ectopic pregnancy is one of the three causes of early pregnancy hemorrhage, beside miscarriage and molar pregnancy. The ampullary type is the commonest; the interstitial type bleeds heavily. It accounts for about 2% of bleeding in the first trimester but is the more common cause of death, and its pain is lateral rather than midline. Where there is bleeding and pain with a closed cervical os, an empty uterus on US and a positive pregnancy test, the label is pregnancy of unknown location, and it is treated as ectopic till proven otherwise.

Causes and risk

The risk factors are:

• PID and chlamydial infection of the tube.
• Previous ectopic pregnancy, previous tubal surgery, previous spontaneous abortion, previous induced abortion.
• Pregnancy in the presence of an IUCD or POP.
• Assisted reproductive technologies such as in vitro fertilization.
• Tobacco, advanced maternal age, and a history of infertility.

PCOS is not a risk factor. On the IUCD the pages disagree: one lists prior ectopic pregnancy among the contraindications to an IUD, while another states that a history of prior ectopic pregnancy is not a contraindication to IUD use, because the overall risk of ectopic pregnancy is lower for women using an IUD than for the general population; if pregnancy does occur, however, IUD users are at higher risk of that pregnancy being ectopic.