American Medical Association Family Medical Guide - American Medical Association [291]
If your doctor confirms that you have an ectopic pregnancy, you will be hospitalized immediately and given fluids intravenously (through a vein), and possibly a blood transfusion if you have lost a lot of blood. If the fallopian tube is ruptured or bleeding, part or all of it may have to be removed. If the remaining fallopian tube is healthy, you still will be able to get pregnant, although the chances of conception are slightly reduced. Sometimes more extensive surgery of the abdominal cavity is necessary to remove the fetus, placenta, surrounding tissue, and any damaged blood vessels.
If an ectopic pregnancy is diagnosed early and has not ruptured, and if the woman is not bleeding or having any pain, the doctor may treat the ectopic pregnancy with one or more injections of the powerful anticancer medication methotrexate and perform a series of blood tests to ensure that the drug is working. Methotrexate breaks down the abnormal tissue, allowing the body to absorb it.
Tubal pregnancy
A tubal pregnancy is a pregnancy that occurs in a fallopian tube when the fertilized egg does not make it all the way into the uterus and instead remains inside the tube. If the fertilized egg continues to grow inside the tube, it eventually can cause the tube to burst, which can be life-threatening.
If you have had an ectopic pregnancy, your doctor may recommend waiting until you have had one or two periods before trying to get pregnant again to give your body a chance to heal. Because a woman who has had an ectopic pregnancy is at increased risk of having another one, you will need to have the pregnancy confirmed as early as possible to make sure it is progressing normally (inside the uterus).
Incompetent Cervix
If a woman has an incompetent cervix, her cervix is weak and dilates (widens) under the weight of the fetus and placenta during pregnancy. The fetus and placenta can drop down out of the uterus, resulting in miscarriage (see page 522), usually after the 14th week of pregnancy. The cause of incompetent cervix is usually unknown, but the cervix sometimes can be weakened from past medical procedures such as a biopsy in which a large amount of tissue was taken from the cervix (cone biopsy). Incompetent cervix also can occur in women whose mothers took the drug diethylstilbestrol (DES) when they were pregnant to prevent miscarriage. (DES was prescribed from the 1940s to the 1970s.)
Incompetent cervix
If a woman’s cervix is weak, the increasing weight of the developing fetus can cause the cervix to open and widen prematurely. As a result, the membranes that surround the fetus may bulge down through the cervix and rupture, causing a miscarriage.
If you are pregnant and have had a miscarriage because of an incompetent cervix, or if your doctor thinks that you may have an incompetent cervix, he or she may perform surgery early in your pregnancy to correct the weakness. For this procedure, you will be given spinal or general anesthesia, and the doctor will tighten your cervix using a piece of strong thread. Your doctor may prescribe medication to reduce the risk that the surgery will stimulate preterm labor (see page 529). He or she may recommend that you rest as much as possible and abstain from sexual intercourse until the delivery. At about the 37th week of pregnancy or when you go into labor, the thread is cut to allow the fetus and placenta to pass through the cervix.
Multiple Fetuses
Twins occur as a result of either the splitting of a single fertilized egg or the parallel development of two fertilized eggs. Twins account for 1 in 90 births in the United States (triplets, by contrast, are uncommon and occur in only 1 in 8,000 births). Two out of three sets of twins are fraternal (nonidentical), which means that two different eggs from the woman were fertilized by two different sperm from the man. Identical twins develop from one egg, fertilized