Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, affecting one in 50 pregnancies. Symptoms include abdominal pain and vaginal bleeding. Treatment options include methotrexate injection or surgery. Women who have had ectopic pregnancies have a good chance of developing normal pregnancies later on.
An ectopic pregnancy, also known as a “tubal” pregnancy, occurs when a fertilized egg implants itself outside the uterus. Surprisingly, this occurs in one in 50 pregnancies. Unfortunately, it all ends in abortion.
In a normal pregnancy, a fertilized egg makes its way down the fallopian tubes to the uterus, where it will make its home for the next nine months. The problem occurs when the tubes are blocked or damaged and the egg cannot get through. A rarer form of ectopic pregnancy occurs when an egg is implanted in the ovary, cervix, abdomen, or C-section scar. Even rarer is a heterotopic pregnancy, in which a woman having a normal pregnancy experiences an ectopic one at the same time. This is more likely to affect a woman undergoing fertility treatments.
An undiagnosed ectopic pregnancy is a serious complication that can result in damage to the fallopian tube or, worse, rupture of the fallopian tube, possibly causing permanent damage or leaking of the tube. It can cause heavy bleeding and, in rare cases, death.
Women at the highest risk of developing this type of pregnancy are those who become pregnant even though they have had tubal ligation, fallopian tube surgery, pelvic or abdominal surgery, or the removal of ovarian cysts or fibroids. Women who have had previous ectopic pregnancies are also at risk. Also at increased risk are women whose mothers took the drug diethylstilbestrol (DES), a synthetic form of estrogen used in the late 1960s to prevent miscarriage, while pregnant with them, and those who are taking a progestogen-only hormonal contraceptive.
Using an intrauterine device (IUD), which prevents implantation, may also increase your risk. Damage to the fallopian tubes from an upper reproductive tract infection caused by pelvic inflammatory disease (PID) may also be a risk factor. Other risk factors include age, smoking and frequent use of douches.
Symptoms of ectopic pregnancy usually occur around week 6 or 7, which is when general pregnancy symptoms begin. However, some symptoms can be detected as early as four weeks. This type of pregnancy doesn’t always trigger home pregnancy tests, so complications usually alert the mother to the problem.
The most common symptom is abdominal tenderness and pain, usually on one side, but often not localized. There is often vaginal bleeding or spotting, as well as increasing pain when coughing or going to the toilet. Shoulder pain is often present and can signal a break, especially if the pain intensifies when lying down.
Since a fertilized egg cannot be transplanted into the uterus once it has implanted outside the uterus, an ectopic pregnancy must be terminated to prevent life-threatening complications for the mother. If pregnancy is not far off and the embryo is still small, the drug methotrexate is injected into the mother to terminate the pregnancy. This prevents the embryo from growing and being reabsorbed into the mother’s body. Side effects of this treatment can include cramping, bleeding, nausea, vomiting, and diarrhea.
If the pregnancy is more advanced, or if the mother is breastfeeding or bleeding internally, surgery may be the only option. In a laparoscopic surgery, the embryo is removed through a small cut in the navel, possibly preserving the fallopian tube. In some cases, if there is excessive bleeding or extensive damage, the tube must be removed. This requires general anesthesia and about a week of recovery time. If the mother has extensive scar tissue in her abdomen or the embryo has grown, she may need abdominal surgery in which the abdomen is opened and the embryo is removed. Since this is major surgery, it takes much longer to heal.
The good news is that women who have had ectopic pregnancies have a good chance – about 85-90% – of developing normal pregnancies later on. Of course, if there is any damage, a doctor will need to closely monitor any subsequent pregnancies. Because an ectopic pregnancy is a physical and emotional loss, those experiencing it should seek the emotional and spiritual support they need to cope.
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