What Causes Ectopic Pregnancy?

It's important to remember that in most cases of ectopic pregnancy, the cause is unknown. However, several
factors can raise your risk for an ectopic pregnancy:

• Fallopian tube problems

• Smoking
• Surgery
• Medications

Fallopian Tube Problems

The fallopian tubes are five- to six-inches long and have funnel-shaped endings. They are designed to pick
up the egg from the ovary and transport it to the womb. The embryo is transported through the tube by a
combination of the contractions of the muscles surrounding the tube and the movement of fine, hair-like cells
lining the tube. After fertilization occurs inside the tube, these "squeeze and sweep" the embryo out of the
fallopian tube and into the uterus.

A damaged fallopian tube can block this motion and keep the embryo from reaching the womb. The most
common causes of tubal damage are:

• Previous pelvic infection. The infections most likely to cause fallopian tube problems are sexually
transmitted diseases (STDs), such as gonorrhea and chlamydia. These STDs can be especially
dangerous for women, because they may not cause any symptoms until the disease has traveled
into the abdominal cavity and infected the reproductive organs. This can lead to serous condition
called pelvic inflammatory disease, or PID. Mild pelvic infections can destroy the delicate hair-like
cells lining the fallopian tubes. Severe infections can scar the tubes, causing them to become
blocked. Women who have had pelvic infections have a five times greater risk of ectopic
pregnancy.
• Use of an intrauterine contraceptive device (IUD). IUD's can place a woman at an increased risk of
pelvic infection, scarring of the fallopian tubes, and ectopic pregnancy.
• Endometriosis is a medical condition that causes uterine tissue to grow outside the womb and
attach itself to internal organs. It can cause damage and scarring to the fallopian tubes, raising the
risk of ectopic pregnancy.

For more detailed information about endometriosis, go to Endometriosis.

Nice to Know: What Is PID?

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. PID is usually caused when
sexually transmitted bacteria, such as those that cause chlamydia or gonorrhea, migrate from the vagina into the
uterus and upper genital tract. Using an intrauterine device (IUD) or having gynecologic procedures such as an
abortion may also introduce bacteria that could cause PID.

Sometimes a woman may have PID and not know it (many times a girl gets it as a teenager). It may be found only
later when she has trouble getting pregnant and a doctor discovers that her reproductive organs have been
damaged, or when she experiences pelvic pain later in life. PID can cause scarring on the fallopian tubes, a prime
risk factor for an ectopic pregnancy

About one million American women receive a diagnosis of PID each year. More than 100,000 women become
infertile as a result of PID and thousands suffer complications of pregnancy, such as ectopic pregnancy. The best
way to prevent PID is to use a barrier method of birth control, such as condoms, that helps prevent STDs.

Symptoms of PID include abdominal pain, irregular periods, abnormal vaginal discharge, and pain during urination
and intercourse. However, many women experience no symptoms. If you have had unprotected sex with multiple
partners, get tested regularly for STDs and have regular gynecological checkups. PID can be cured with antibiotics,
but left untreated it can cause infertility and even be life-threatening.

Smoking

Smoking is also associated with up to a five times greater risk of ectopic pregnancy. This may be due to the
nicotine in cigarettes. Nicotine stimulates contractions in the fallopian tubes. This can cause "spasm,"
resulting in temporary blockage of the tube so the embryo cannot pass through.

Surgery

Previous abdominal surgery, particularly surgery involving the reproduction system increases the chance of
having an ectopic pregnancy. In particular, when pregnancy occurs after an unsuccessful tubal sterilization,
there is a 50/50 chance that it will be ectopic. In addition, if a woman has her tubal ligation (a procedure in
which the fallopian tube is surgically severed in order to prevent pregnancy) reversed, she is at a high risk
for ectopic pregnancy. This is because the tube may be narrowed at the spot where it was rejoined.
Because of the high risk of ectopic pregnancy, if you become pregnant after surgery to your fallopian tubes,
you should be seen by a doctor immediately.

Medications

Several hormonal medications have also been associated with ectopic pregnancies. These include:

• Fertility drugs such as clomiphene citrate and pergonal

• Contraceptive hormonal medications that contain progesterone-like hormones

Each of these hormonal medications may predispose women to tubal pregnancies by altering the ability of
the fallopian tube to contract and squeeze the embryo through to the womb. If you conceive while on one of
these medications, get evaluated by a doctor right away.

Tubal pregnancy.

If the fertilized egg gets trapped in the tube on its way to the cavity of the womb , it will implant in the lining
or mucous membrane of the tube and start to develop. The thin wall of the tube can't stretch to
accommodate the growing pregnancy and the wall eventually ruptures. This will cause severe pain and
internal bleeding.
It possible to diagnose a tubal pregnancy before it rupture. Pain is already present before tubal rupture
occurs. We stress again pain should always be investigated. Especially pain after an absent period. Never
hope it will go away on it's own. The investigations our doctor will conduct in cases of pain could lead to the
detection of a tubal pregnancy before it ruptures.

When the tube ruptures, the pregnancy starts to die and the hormonal levels start dropping. This can lead to
endometrial bleeding. This bleeding starts late ( 1 - 3 weeks late). This an ectopic pregnancy can be
confused with a miscarriage. In modern times the availability of sonar examinations helps tremendously to
exclude intra uterine pregnancies in cases of suspected ectopic pregnancies. Laparoscopies confirm the
diagnosis and it is possible to treat this condition in some patients via the laparoscope and this avoiding
open surgery.

The treatment is surgical removal of the abnormal pregnancy. If the tube is just stretched but not ruptured ,
the surgeon will attempt to remove the pregnancy with the minimum possible damage to the tube . In some
institutions this will be possible via a laparoscopic technique , otherwise open surgery will be required. If the
tube is already damaged ( ruptured) than the ruptured part is removed ( partial salpingectomy). This will
cause the tube to be blocked . As long as the other tube is still functioning , it won't cause infertility.

A graphic illustration will appear lower down the page.

An Ovarian Pregnancy

In this case an egg cell is not guide into the tube but is fertilized in the peritoneal cavity and than implants
onto the ovary. It causes the same symptoms as a tubal pregnancy and severe internal bleeding will
eventually occur. It has to be removed surgically. This is a very rare condition.

A graphic illustration will appear lower down the page.

An Intra Abdominal Pregnancy

The cause is probably the same as in an ovarian pregnancy. An egg cell is not guided into the tube and
fertilized in the peritoneal cavity. It than implants any where on the peritoneal cavity. These pregnancies can
develop quite far and continue for months before it is diagnosed. There are a few findings that will alert a
doctor and lead to further investigations. The diagnosis is usually confirmed by a sonar examination. The
fetus is seen separate from the uterus during a sonar investigation. This condition is potentially very
dangerous and the pregnancy is usually removed when diagnosed. A few cases of viable life babies were
described in the world literature. The incidence of abnormalities are very high due to pressure on the fetus.
( the fetus is outside the womb and lacking the protection of the wombs thick muscles.)

This condition is rare . A graphic illustration will appear lower down on the page.

A Cervical Pregnancy

A cervical pregnancy occurs when the fertilized egg cell passes through the cavity of the womb into the
cervical canal and starts developing here. The cervix can't accommodate a pregnancy and bleeding will
eventually occur. The pregnancy is also not viable and will also have to be removed surgically. This is a rare
condition.

A graphic illustration will appear lower down.