An ectopic pregnancy is a pregnancy that occurs outside of the normal parts of the uterus. About one to two percent of all pregnancies are ectopic, but they account for about nine percent of maternal deaths. An ectopic pregnancy is often called a tubal pregnancy because the vast majority of them occur in the fallopian tubes. Other possible places for the embryo to implant would be the abdomen, ovary, cornua (where the fallopian tube and the body of the uterus meet), the cervix, or a previous cesarean scar.
The problem with this type of pregnancy is that it is not viable, meaning it will not grow into a healthy baby, and frequently causes damage to a woman’s body. Because the majority of these pregnancies occur in the fallopian tubes, there is a great risk of rupture in the tube as the pregnancy grows, which can lead to internal bleeding and even death when not treated.
What causes an ectopic pregnancy?
There are many potential causes of an ectopic pregnancy. You are more likely to have an ectopic pregnancy if you:
have had pelvic inflammatory disease (PID)
have had a tubal ligation (female sterilization)
have scarring in the fallopian tube
have had previous pelvic or abdominal surgery, including cesarean section
have had a previous ectopic pregnancy
have a history of smoking
have had fertility treatments
What are the symptoms of an ectopic pregnancy?
One of the most common symptoms of an ectopic pregnancy is one-sided pain in the lower abdomen in pregnancy. You can also have more generalized pain. Sometimes the pain seems to come and go, but other times it may not stop at all. Some people will have intense pain, while others may feel only mild pain.
Dizziness and feeling faint, usually from blood loss, is not an unusual symptom with ectopic pregnancy. If you have internal bleeding, you may also experience intense shoulder tip pain. If you experience this symptom, you should report it to a doctor immediately.
Some women will experience bleeding. Any bleeding during pregnancy should warrant a call to your doctor or midwife. They can help guide you if you have bleeding or any other symptoms of an ectopic pregnancy.
How do you diagnose an ectopic pregnancy?
There are a couple of tests that can help in the diagnosis of an ectopic pregnancy. The first and most basic is a pelvic exam. This may accompany an ultrasound exam. These methods may be able to show a pregnancy that is located in the wrong place or show whether there is fluid in certain areas. Occasionally it’s too early to see much.
Your practitioner may order blood tests to look at the level of human chorionic gonadotropin (hCG). This test may need to be repeated more than once to watch the numbers. Numbers that drop or have an abnormal rate of rise may indicate a problem.
How is ectopic pregnancy treated?
There are three main treatments for ectopic pregnancies. The treatment depends on the length of the pregnancy and the symptoms that you are experiencing.
The first treatment is called expectant management. Some very early ectopic pregnancies can be managed by watchful waiting. This involves serial blood tests to watch the hCG levels until they reach zero, with no treatment unless indicated.
The second treatment is a medication treatment. If the pregnancy is early and the tube is intact, you may be given a special medication that will cause the pregnancy to stop and to release from its abnormal location.
The final treatment is surgery. If your tube has ruptured or you have certain other symptoms, it surgery may be the best option. Typically this surgery is to remove the affected fallopian tube. This is done to prevent blood loss and infection.
Can you get pregnant again after an ectopic pregnancy?
After you have had an ectopic pregnancy, you may wonder about future pregnancies. The vast majority of people who want to get pregnant after an ectopic pregnancy do so. One study showed that there was about a two-thirds normal pregnancy rate.
That said, if you had surgery to treat the ectopic pregnancy, you are slightly less likely to get pregnant again, but also less likely to have a recurrence of the ectopic pregnancy. If you had conservative treatment, i.e., the expectant management or the medication management, you are more likely to get pregnant, but slightly more likely to have a recurrence of ectopic pregnancy.
This information may play into your decision about which treatment is best for you at the time of your ectopic pregnancy. You and your practitioner will make the best decision for you and your future fertility.
American College of Obstetricians and Gynecologists. Ectopic Pregnancy. June 2017. Accessed November 2016.
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Robin Elise Weiss, Ph.D., LCCE, CLC, AdvCD(DONA) is a childbirth educator, doula, founder of Childbirth.org, and the award-winning pregnancy and parenting author of “The Complete Illustrated Guide to Pregnancy” and more than 10 other books. Between her nine children, teaching childbirth classes, and attending births for more than two decades, she has built up an impressive and practical knowledge base. You can follow Robin on Twitter @RobinPregnancy, Instagram, and Facebook.