One Ectopic Often Predicts Another
Your chances of having a normal
pregnancy are excellent, but your chances of having another ectopic
pregnancy have also increased.
I had an ectopic pregnancy two years ago, and they
treated it with a medication called methotrexate. What are my chances of
having a normal pregnancy now, and what I should watch out for?
Answer: Jan. 22,
2001 -- Your chances of having a normal pregnancy are excellent, but
your chances of having another ectopic pregnancy have also increased. An
ectopic pregnancy -- one that's developing outside the uterus -- is
diagnosed in about one in every 100 pregnancies. More than 95% develop
in the fallopian tube, but these pregnancies can also occur in an ovary,
the cervix, or even the abdomen. Risk factors for them include a
previous ectopic pregnancy; tubal surgery such as tubal ligation or
sterilization reversal; a past tubal infection; use of an intrauterine
device (IUD); use of the "morning-after" pill; use of the
progesterone-only or "mini" pill; and fertility treatments including in
vitro fertilization and gamete intrafallopian transfer.
Ectopic pregnancy has traditionally been treated with
surgery, which may involve removing the fallopian tube or removing the
embryo. Nonsurgical treatment can be used in cases where the ectopic
pregnancy is early and hasn't ruptured. It involves the injection of a
chemotherapeutic medication, methotrexate, which halts the pregnancy's
In general, after one ectopic pregnancy your chances of
having a future pregnancy that is in the uterus are about 60-70%. But
women with a history of ectopic pregnancy often have difficulty getting
pregnant again, and as many as 20-30% of them end up being infertile,
especially if they have any of the risk factors noted above. Your risk
of having another ectopic pregnancy is much higher once you've had the
first; as many as one in 10 women will have a second ectopic pregnancy.
The increased risk is probably about the same whether your ectopic was
treated with surgery or medication, though it's too early to have much
data on this.
Because the risk of a second ectopic pregnancy is so
high, you should take precautions when you get pregnant again. If you
miss a period and might be pregnant, let your doctor know right away.
The first step is to find out if you are pregnant and where the
pregnancy is located. This may be difficult early in the pregnancy, so
be aware of the early signs of an ectopic pregnancy, such as pain and
vaginal bleeding or spotting.
With your history, your doctor may assume you're having
another ectopic pregnancy until an intrauterine pregnancy can be clearly
seen on ultrasound. Your doctor will examine you, do a transvaginal
ultrasound, and draw your blood for an hCG level if a pregnancy is not
yet visible. When the hCG rises above 2,000 mIU/mL, your doctor should
be able to see an intrauterine pregnancy; the same is true around 28
days after you last ovulated (about six weeks after your last period).
Sometimes an additional blood sample for hCG level is taken 48 hours
after the first and compared with the first level. An hCG level that
increases but is less than double the previous one is considered
abnormal and suspicious of an ectopic pregnancy.
Otherwise, your doctor will prescribe additional
observation and testing. Once the pregnancy is confirmed to be inside
the uterus, there's usually no further need for concern about an ectopic
Amos Grünebaum is a practicing
obstetrician and gynecologist in New York specializing in high-risk