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What is an ectopic pregnancy?
An ectopic pregnancy is when a fertilized egg (called an embryo) attaches itself outside of the womb. The embryo should be in the womb (often referred to as the uterus). Instead, it starts growing in another area of the reproductive system. It usually happens in the fallopian tubes.
The embryo can still continue to grow. But it will not be able to lead to a healthy baby. While not common, an ectopic pregnancy requires immediate medical attention.
It is a rare but serious condition that can cause heavy, life-threatening bleeding. (Also known as hemorrhaging.)
For every 100 pregnancies, 1 to 2 will be ectopic. Odds are higher for those who have previously had an ectopic pregnancy.
How soon would you know if you had an ectopic pregnancy?
There may not be any signs and symptoms that the pregnancy is ectopic until the fertilized egg grows big enough to put pressure on the fallopian tubes or organs near to wherever it is attached.
If you are pregnant, experiencing severe pain, and think you may have an ectopic pregnancy, get immediate medical attention. It is especially important if you have not had an ultrasound that confirmed the pregnancy is in the uterus.
Main symptoms of ectopic pregnancy
- Severe, sharp, sudden abdominal pain. It's usually around or below the belly button area, but sometimes is felt on the right or left side or lower back.
- Vaginal bleeding
- Pain with vomiting and/or diarrhea.
- Internal bleeding may lead to a fast heartbeat, dizziness, confusion, fainting, and even complete loss of consciousness.
- Internal bleeding may also cause you to feel pain in other areas, including the shoulder area.
Ectopic pregnancy risk factors
- Sexually transmitted diseases (STD) like chlamydia and gonorrhea, especially if never treated.
- Pelvic inflammatory disease (PID), whether caused by an STD or another kind of infection.
- A previous ectopic pregnancy. Increases the risk but does not mean it will definitely happen again.
- Surgery involving the fallopian tubes.
- Fertility treatments.
- Pregnancy at age 35 and older.
Causes of ectopic pregnancy
It is important to understand that most of the time, people who have an ectopic pregnancy do not have another. Though the risk of having a repeat ectopic pregnancy is higher. - Dr. Eduardo Hariton
There are many reasons an ectopic pregnancy occurs. Ectopic means out of place—the pregnancy is not where it should be.
The majority of ectopic pregnancies are in the fallopian tube. In rare instances, the embryo may go in other organs like the ovary, the cervix, or a caesarian section scar.
The most common cause is damage to the fallopian tubes. Instead of the embryo traveling down the tube and into the uterus, it gets stuck in the tube. It can still grow, which is why pregnancy hormones will be released.
If untreated, the embryo will continue to grow and may cause the tube to break (rupture).
Signs of a ruptured fallopian tube include dizziness, abdominal pain, diarrhea, nausea, vomiting, lightheadedness, fainting, or total loss of consciousness. It could be a life-threatening situation. Go to the ER immediately.
How painful is an ectopic pregnancy?
An ectopic pregnancy can be very painful, though it varies from a mild cramping to an intense stabbing sensation.
Generally, the first signs are pain in the lower abdomen—around the same area as cramps during a period—and vaginal bleeding.
At first, symptoms often mimic the beginning stages of pregnancy. This could mean having breast tenderness and feeling nauseated. If you take a pregnancy test, you will test positive. Your body thinks it's pregnant and starts releasing hormones to support it.
Can a baby survive during an ectopic pregnancy?
You can have an ectopic pregnancy and a normal pregnancy at the same time. It is called a heterotopic pregnancy.
It's rare—about 1 in 3,900 cases. But it happens from time to time. The ectopic pregnancy can be treated without putting the viable pregnancy at risk.
How fallopian tubes become damaged
- An untreated or delayed treatment for an infection can lead to scarred, damaged tubes.
- STDs such as chlamydia and gonorrhea can cause inflammation and eventually, pelvic inflammatory disease and scarring.
- Surgery involving the fallopian tubes.
- Smoking (including second-hand) may lead to blockages.
- If your mom took a drug known as DES during pregnancy, there's an increased chance of having many health issues. One of the risks is complications during pregnancy like an ectopic pregnancy.
What happens if you have an ectopic pregnancy?
Many factors determine how a doctor treats an ectopic pregnancy. Factors like how far along the pregnancy is, the location of the pregnancy, and whether you have other health conditions.
If a doctor thinks you have an ectopic pregnancy, they will usually do the following
- A blood test to check hCG levels.
- Ultrasound imaging (also known as a sonogram) either on top of the stomach area or inside the vagina. (This is a transvaginal ultrasound). The doctor is checking whether there is a fertilized egg in the uterus, which is where it should be. Or if it's in another location—meaning it’s ectopic—like the fallopian tubes.
- Early in the pregnancy—less than 6 weeks or so—the doctor may not be able to see the egg. In that case, the doctor will monitor hCG levels with regular blood tests.
Many patients know someone or of someone who had an ectopic pregnancy and did not have complications. But untreated ectopic pregnancies can be life threatening. It's imperative to follow the doctor's recommendations. And not to delay care, even if it isn't the outcome you desired. - Dr. Hariton
Ectopic pregnancy treatments
If the pregnancy is in the early stages and there aren't any signs of bleeding, the doctor may give an injection of the medication methotrexate to stop the pregnancy from growing. One dose or multiple doses may be required.
Your doctor may ask for regular blood tests for a few weeks until there isn't any hCG in the blood.
Surgery is the usual treatment for ectopic pregnancy. When the egg is in one of the fallopian tubes (most common), then part or all of a damaged tube will be removed or repaired. Whenever possible, especially if not an emergency, doctors will do it laparoscopically. (Which is through small incisions using a camera).
Sometimes a doctor will wait and see if the ectopic pregnancy goes away on its own. It has to be an early pregnancy with no symptoms and low hCG levels.
This treatment requires regular monitoring. There will be frequent blood tests and ultrasounds. There's also the possibility of a tube rupturing.
You need to have a follow-up appointment with your doctor or ob-gyn. Follow-up includes regular blood tests. Your doctor will let you know when it's OK to have sex again.
Prevention for ectopic pregnancy
While you can't stop an ectopic pregnancy from happening, there are ways to make it less likely. (And remember, it is not something that happens often.)
If you know or suspect you are pregnant, catch it early by seeing an OB-GYN.
- The single most important preventative tip is to get tested regularly for STDs. If you think you might have an infection, see a doctor. An untreated STD, even when symptoms have gone away, can lead to serious health issues.
- If you test positive for an STD, start treatment right away. Take all prescribed antibiotics for as many days as the doctor tells you. Symptoms may stop even when you still have an infection. It can also create bacteria that are resistant to antibiotics.
- Always use condoms when having sex with a new partner or a partner who has not been tested.
- Don't smoke or be around someone who regularly does. It can damage the cells of the fallopian tubes.
- Tell your doctor if you've had an ectopic pregnancy and are planning on getting pregnant again.
Dr. Dasani is a resident physician at Penn and Brigham and Women's Hospitals. She graduated from Columbia University in 2013 with a BA in Neuroscience and Behavior. Upon graduation, she served as a Fulbright scholar on the island, Bangka, Indonesia. After her Fulbright, she pursued a MD/MBA at Penn during which she worked on various health care consulting projects solving problems across multiple sectors of the health care system. She is currently a medicine resident physician at Penn and is planning to continue her anesthesia training at Harvard starting in July 2020. She is primarily interested in increasing the efficiency of health systems delivery with attention to patient safety, specifically within the perioperative realm.