For some women, the idea of an ectopic pregnancy is a conceptual diagnosis that has never come to mind, for others it is a very real concern. Here, we cover the symptoms, diagnosis, and treatment of ectopic pregnancy, including the causes and who might be at risk.
Also known as tubal pregnancy, an ectopic pregnancy is relatively rare, occurring in about 1 of every 50 pregnancies. A diagnosis of which can be emotionally difficult for any woman trying to get pregnant, as pregnancy concerns as well as concern for maternal safety come into play. In short, a diagnosis means the fertilized egg isn’t able to survive and develop to full term, and the main focus shifts to maternal health and wellbeing due to the severity of risks if left untreated.
What Is an Ectopic Pregnancy?
This condition occurs when an embryo implants somewhere in the body other than the uterus, typically taking place in the fallopian tubes. During a typical pregnancy, once fertilized, a newly-formed embryo will stay in the fallopian tube for about three to four days. After this time period, the embryo will travel from the fallopian tube and implant into the lining of the uterus where it continues to develop into a healthy fetus.
With an ectopic pregnancy however, the embryo forms and then implants in the fallopian tube. In more rare cases it is possible that the embryo will implant in the cervix, ovary, or abdominal cavity. While implantation does occur, because it does not occur in the uterus where pregnancy takes place, the embryo cannot properly develop, and moreover, the pregnancy can’t continue naturally due to the health risks that arise to the mother. When diagnosed, this condition must be treated as a medical emergency requiring urgent attention, as life-threatening risks to the mother, from infection and/or a ruptured fallopian tube, begin to rise if the condition is left untreated.
Causes and Risk Factors
When it comes to an ectopic pregnancy, in most cases, this condition is caused by a blockage or inhibited movement of the egg through the fallopian tube. This can be due to infection or inflammation in the fallopian tube or the presence of cysts or other mass.
The most common cause of ectopic pregnancy is the condition of pelvic inflammatory disease (PID), which affects more than 1 million women in the United States each year, and can result in scar tissue formation that hinders the movement of the egg through the fallopian tube. Additionally, polycystic ovarian syndrome (PCOS), which affects one in five women, is another possible cause of ectopic pregnancy as it can lead to cyst formation that blocks the fallopian tube pathways.
This condition has a number of risk factors associated with it and is more likely to occur in women who:
- Have a history of sexually transmitted diseases
- Have had an unsuccessful tubal ligation procedure, or have had a tubal ligation reversal procedure
- Have a history of pelvic inflammatory disease (PID)
- Have previously had an ectopic pregnancy
- Have previously had pelvic surgery
- Have endometriosis
- Have polycystic ovarian syndrome (PCOS)
- Have conceived while an intrauterine device (IUD) is in place
- Undergo fertility treatments and/or are using fertility drugs
In each case of ectopic pregnancy, it’s difficult or impossible to tell the exact cause of the failed implantation into the uterus, and in all cases of ectopic pregnancy, there is no preventative measure that could have been taken to prevent this condition from occurring.
Symptoms and Diagnosis
When an ectopic pregnancy occurs, the first signs of this condition may present itself in the form of pelvic pain, with or without bleeding. Other common symptoms include:
- Abdominal cramping, which is often severe and may be sharp or stabbing
- Pain in the pelvis, neck or shoulder, due to blood pooling under the diaphragm after a rupture
- Breast tenderness
- Vaginal bleeding, heavy or light in severity
- Gastrointestinal issues
- Nausea, accompanied by pain
- Vomiting, accompanied by pain
Symptoms of ectopic pregnancy should be diagnosed by a health care practitioner immediately, thus it is essential that if any of the symptoms are present or you are concerned about an ectopic pregnancy, your doctor be contacted immediately for evaluation. If heavy vaginal bleeding accompanied by fainting, lightheadedness, and pain are present, it is vital that you visit an emergency treatment facility immediately, as these are symptoms of a potential ruptured fallopian tube and will need to be treated as a medical emergency.
During routine exams or emergency screenings, an ectopic pregnancy is diagnosed with a pelvic exam to locate the source of the pain. Additionally, an ultrasound may be performed to ensure the fallopian tubes have not ruptured and to determine the condition of the uterus. A pregnancy or blood test may also be given to measure hCG and progesterone levels and determine if they are within normal range or have dropped, as low levels could be a sign of an ectopic pregnancy.
In addition, your physician may choose to perform a culdocentesis, a procedure in which a needle is inserted behind the uterus at the very top of the vagina and in front of the rectum. The culdocentesis procedure checks for the presence of blood in this area, which can indicate bleeding from a ruptured fallopian tube.
Treatment of an ectopic pregnancy is determined based on how far the condition has progressed and how severe symptoms currently are, however medication or surgery are the only options.
In the early stages of an ectopic pregnancy, a doctor can inject a medication called methotrexate, which may also be referred to by the brand name Trexall. This methotrexate medication prevents the cells of the embryo from developing any further, and in most cases the cells are reabsorbed by the body. In many cases of ectopic pregnancy, this medication is the viable treatment. For those receiving a single dose of the medication, the average time for resolving an ectopic pregnancy is approximately 32 days, while it may take up to 58 days for those women who receive two or more doses.
Ectopic pregnancies that are further along or if the fallopian tube has stretched, ruptured, or has begun bleeding, a surgery will need to be performed to remove the part or all of the fallopian tube. In many cases, laparoscopic surgery is possible, using only a small incision in the lower abdomen. During this surgery a surgeon will remove the ectopic pregnancy and repair or remove the affected fallopian tube. If the unaffected fallopian tube looks healthy, surgeons will generally remove the entire affected fallopian tube, however trying to remove the pregnancy without removing the whole tube may be attempted.
After surgical treatment, your doctor will perform a blood test to looks for hormone changes that indicate pregnancy to confirm that the pregnancy has ended so you are no longer at risk for serious and even life-threatening issues.
Most women who have experienced an ectopic pregnancy are able to have a healthy pregnancy afterward, even in cases where one fallopian tube was completely removed. Some health care providers recommend waiting for three to six months before trying to get pregnant again, and your doctor or health care provider may also recommend visiting a fertility specialist before trying again. Although removal of one fallopian tube may make it more difficult to get pregnant again, it is still possible.
For women who have previously been treated for an ectopic pregnancy, there is a 10 percent risk of recurrence, which is why it’s important to work with your doctor and healthcare team when planning for a future pregnancy.