Ectopic Pregnancy: Symptoms, Causes, and Treatment
The good news is that ectopic pregnancies are rare. However, when they occur they require medical attention, so it’s helpful to be informed, just in case. Learn more about what an ectopic pregnancy is, and what the symptoms, risk factors, and treatment options are.
What Is an Ectopic Pregnancy?
In a typical pregnancy that develops normally, a fertilized egg moves through the fallopian tube toward the uterus, where it implants and starts to grow. But, in an ectopic pregnancy, the fertilized egg implants outside of the uterus. Ectopic pregnancies are quite rare — making up just 2 percent of pregnancies. In more than 90 percent of ectopic pregnancies, the fertilized egg attaches itself to the wall of the fallopian tube. This condition is called a tubal ectopic pregnancy. Occasionally the egg implants in the ovary, cervix, or abdominal cavity. Only the uterus can hold a growing embryo, so in these other cases, the pregnancy cannot progress.
A tubal ectopic pregnancy can cause the fallopian tube to burst, resulting in internal bleeding. This requires emergency medical treatment, as it can be life-threatening.
Sometimes you might hear terms like “extrauterine” and “intrauterine.” Extrauterine pregnancy is another name for ectopic pregnancy, and intrauterine pregnancy refers to the fertilized egg implanting normally in the lining of the uterus.
For women who got pregnant via in vitro fertilization (IVF), there is a 1 percent chance of what is called a heterotopic pregnancy. This is when an intrauterine pregnancy occurs at the same time as an ectopic pregnancy. For women who got pregnant naturally, the risk of this is much lower and is estimated to range from 1 in 4,000 to 1 in 30,000.
Signs and Symptoms of an Ectopic Pregnancy
It can be difficult to recognize the signs and symptoms because they can start very early in your pregnancy — at a time when you might not know you are pregnant yet. In addition, some of the indicators are also normal signs of a healthy pregnancy that you might experience in the first trimester. Although the risk of ectopic pregnancy is low, it helps to be aware of the early symptoms, which can include:
Abnormal vaginal bleeding. Bleeding in early pregnancy can also be implantation bleeding, so consult your doctor.
Lower back pain
Mild pain or cramping in the abdomen or pelvis. Tell your doctor if you experience this.
As the pregnancy progresses, the symptoms can become more severe. You should contact your healthcare provider right away or go straight to the emergency room if you notice:
A sharp pain in the pelvis, abdomen, or shoulder
Weakness, dizziness, or fainting. Feeling dizzy or light-headed may be caused by internal bleeding due to a ruptured fallopian tube.
Keep in mind that your healthcare provider is the right person to make a diagnosis.
Your doctor can make a diagnosis using an ultrasound to see where the pregnancy is developing and/or a blood test to measure levels of the pregnancy hormone hCG. The results may not be clear right away, so you may need another test a few days later. In some cases, your doctor may notice the ectopic pregnancy during your first pregnancy scan.
Ectopic Pregnancy Treatment Options
An ectopic pregnancy cannot move itself or be moved to the uterus, and it can’t continue to progress anywhere but in the uterus. That’s why treatment involves ending the pregnancy either by surgery or by medication. Your doctor will explain which option is best for you.
For an ectopic pregnancy, the most common drug used is methotrexate. This medication stops the cells of the embryo from growing, which ends the pregnancy. Then, over about four to six weeks, your body absorbs the pregnancy tissue. The benefit of this option is that the affected fallopian tube may not need to be removed, and you may be able to avoid surgery. This option may be recommended if the fallopian tube has not ruptured, and if you’re able to return for regular blood tests to check your hCG levels until it is no longer found in your blood. This option may not be available or advisable if you’re breastfeeding or have certain health issues.
Methotrexate may be given in one or more doses. The risk of fallopian tube rupture only goes away once treatment is complete, so if you develop symptoms such as sharp abdominal or shoulder pain, or feeling faint or weak, seek medical help right away, as these are potential signs of internal bleeding resulting from a rupture. Side effects of methotrexate may include nausea, vomiting, and vaginal bleeding or spotting. During treatment and until your doctor gives you the all-clear, it's best to avoid heavy exercise, taking vitamins and foods containing folic acid, taking anti-inflammatories like ibuprofen, having sex, and prolonged exposure to the sun.
If a fallopian tube has ruptured, emergency surgery is needed, but sometimes surgery may be needed even if a tube hasn’t burst. The ectopic pregnancy may be removed from the tube leaving the tube in place, or the tube — together with the pregnancy tissue — may be removed. Typically, laparoscopic surgery is chosen. This involves small incisions being made in your abdomen while you’re under a general anesthetic. During surgery the pregnancy tissue is removed, and the affected tube is repaired or removed.
In a smaller number of cases, a larger incision of the abdomen may be required, usually in cases where the pregnancy is further along, or if a rupture of the fallopian tube is suspected.
Your healthcare provider will recommend a course of treatment and explain all the risks and side effects, which can include bleeding and infection following surgery. After surgery, follow-up care is required, and your doctor will closely monitor your recovery, including rechecking your hCG level to make sure the ectopic tissue has been completely removed.
Causes of an Ectopic Pregnancy
Ectopic pregnancy happens when the fertilized egg cannot make its way down the fallopian tube to the uterus. This could be a result of scar tissue on the fallopian tube from a past surgery, which blocks the egg’s path to the uterus. Other potential factors that may play a role include an abnormal shape or an inflammation of the fallopian tube, abnormal development of the fertilized egg, or hormonal imbalances.
Although about half of all women who have an ectopic pregnancy don’t have any of these risk factors, the chance is higher if
you’ve had an ectopic pregnancy before
you’ve had surgery on a fallopian tube, or on other areas of your pelvis or abdomen
you’ve had certain sexually transmitted infections
you’ve had pelvic inflammatory disease
you have endometriosis.
Other factors that may increase your risk include if
you’re more than 35 years old
you have a history of infertility
Getting Emotional Support
It’s completely natural to feel anxiety, fear, or grief at this time, even if you only knew you were pregnant for a short while. The treatment itself can also cause you to feel tired or as if you are still pregnant, which can compound the feelings you may have. You might find counseling helpful, or you can seek support in online forums where you’ll find other women who have had a similar experience. Reach out to your loved ones for extra support. It might help to give yourself extra time to rest and recuperate after the treatment, too, so you can recover physically and come to terms with what you’ve been through.
Getting Pregnant After an Ectopic Pregnancy
If you're wondering if you can have a healthy pregnancy after an ectopic pregnancy, your best bet is to speak with your doctor, who will be able to provide you with specific guidance based on your medical history. If the affected fallopian tube has been left intact, there is a good chance you can have a normal pregnancy in the future; also, if one fallopian tube has been removed, an egg and sperm may still join in the other tube, and the fertilized egg may make its way to the uterus.
Keep in mind, though, that having had an ectopic pregnancy increases your risk next time, so during future pregnancies, watch out for the signs and symptoms until your doctor confirms the egg has implanted in the right place — your uterus.
Ectopic pregnancies are relatively rare, but if you notice any symptoms that worry you, consult your provider for reassurance and advice.
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