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Question 29. If I had a previous ectopic pregnancy, what should I do to avoid another one?

Posted Jun 23 2010 12:29pm
Sorry for the delay in between blog posts. Unfortunately, my number one fan (my Mom) has been in and out of the hospital in Boston and I just have been too busy to sit down and do some blogging. At 87 years of age there is not a lot that can be done as she has a lot of health problems and a recent round of chemo almost did her in...But she is hanging in there and I try to talk to her every day. It has been said that gynecologists are either perverts or Mothers' boys...I will let you guess which category this Eagle Scout falls into.

Ok so back to the 2nd Edition of the 100 Q&A book (which I am currently doing final editing of for a Fall pub date)....Today we are discussing ectopics. Why? Because it is Question 29.... Let's be honest here....ectopics really stink. Patients that have had an ectopic will do anything possible to avoid another ectopic. Fortunately, with early identification most ectopics can be treated medically with methotrexate avoiding the need for a surgical procedure. However, methotrexate may not always be successful and patients can end up with an emergency surgery in spite of our best efforts.

29. If I had a previous ectopic pregnancy, what should I do to avoid another one?

The reported incidence of tubal or ectopic pregnancy in the general population is 1%. Women who have experienced an ectopic pregnancy generally have a 10% to 15% risk for another ectopic pregnancy. The good news is that most women who have had an ectopic pregnancy will not have another one. The bad news is there are no options available to eliminate this risk entirely except adoption. All women who are attempting to conceive inherently are at risk for an ectopic pregnancy. Even women with absent or obstructed fallopian tubes can experience an ectopic pregnancy if the embryo becomes implanted in the section of the fallopian tube found within the muscle of the uterus (called an interstitial or cornual pregnancy). The rate of ectopic pregnancy following IVF is usually 1% to 2%, far lower than the 15% recurrence risk with a spontaneous pregnancy.

Fortunately, most ectopic pregnancies are readily diagnosed very early in pregnancy using blood hormone assays for beta human chorionic gonadotropin (HCG) combined with transvaginal ultrasonography. It is now uncommon for such pregnancies to go undiagnosed or to lead to tubal rupture, hemorrhage, or death. Most ectopic pregnancies can be treated medically using low doses of methotrexate (a type of chemotherapy that selectively destroys the pregnancy tissue), thereby avoiding surgery. This medical therapy is 80% to 95% effective.

Kristin comments
I had an ectopic pregnancy after a Clomid cycle that was monitored by my OB. I was 8 to 9 weeks pregnant and thought I was having a miscarriage when the ectopic pregnancy was confirmed at my first RE appointment. Unfortunately, the methotrexate therapy did not work, and I had to have surgery to remove my right fallopian tube. After determining that my remaining tube was not blocked through an HSG, and with the counsel of our new RE, we opted to move on to IVF. This option would offer the greatest chance for us to become pregnant and avoid another ectopic pregnancy.

When I did become pregnant through IVF, my RE agreed to a very early ultrasound to make sure that the pregnancy was in my uterus. I appreciated that my RE understood my concerns of having another ectopic pregnancy. He treated me as an individual instead of requiring me to wait until the typical 7-week mark to perform an ultrasound.
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