What is an Ectopic Pregnancy?

O. Wallace

An ectopic pregnancy, also known as a “tubal” pregnancy, occurs when a fertilized egg is implanted outside of the uterus. Surprisingly, this occurs in one out of 50 pregnancies. Unfortunately, all end in termination of the pregnancy.

Shoulder pain may occur with an ectopic rupture.
Shoulder pain may occur with an ectopic rupture.

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 make it 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 who has a normal pregnancy experiences an ectopic one simultaneously. This is more likely to affect a woman undergoing fertility treatments.

Pain on one side of the abdomen is common with an ectopic pregnancy.
Pain on one side of the abdomen is common with an ectopic pregnancy.

An undiagnosed ectopic pregnancy is a serious complication that can result in damage to the Fallopian tube, or worse, Fallopian tube rupture, possibly causing permanent damage or loss of the tube. It can cause heavy bleeding and, in rare cases, death.

An ultrasound may be required to help determine if an ectopic pregnancy is present.
An ultrasound may be required to help determine if an ectopic pregnancy is present.

Women at higher risk for developing this type of pregnancy are those who become pregnant even though they have had a tubal ligation, surgery on the Fallopian tubes, pelvic or abdominal surgery, or removal of ovarian cysts or fibroids. Women who have had previous ectopic pregnancies are also at risk. Also at higher risk are women whose mothers took the drug diethylstilbestrol (DES), a synthetic form of estrogen used in the late 1960s to prevent miscarriage, while she was pregnant with them, and those who are taking a progestin only hormonal contraceptive.

Successful pregnancies are usually possible after an ectopic pregnancy.
Successful pregnancies are usually possible after an ectopic pregnancy.

Using an intrauterine device (IUD), which prevents implantation, can also increase the risk. Damage sustained to the Fallopian tubes from an infection of the upper reproductive tract caused by pelvic inflammatory disease (PID) can also be a risk factor. Other risk factors include age, smoking and the frequent use of douches.

A diagram of the female reproductive system.
A diagram of the female reproductive system.

Symptoms of ectopic pregnancy usually occur around the sixth or seventh week, which is when the general symptoms of pregnancy usually start. Some symptoms can be detected as early as four weeks, however. This type of pregnancy doesn't always trigger home pregnancy tests, so usually the complications alert the mother to the problem.

An ectopic pregnancy may not trigger a home pregnancy test, so the complications often alert the woman first.
An ectopic pregnancy may not trigger a home pregnancy test, so the complications often alert the woman first.

The most common symptom is abdominal tenderness and pain, usually on one side, but often non-localized. Often, there is vaginal bleeding or spotting, as well as increasing pain when coughing or going to the bathroom. Pain in the shoulder is often present and can signal a rupture, especially if the pain intensifies when lying down.

A rare form of ectopic pregnancy occurs when an egg is implanted in the scar from a previous c-section.
A rare form of ectopic pregnancy occurs when an egg is implanted in the scar from a previous c-section.

Because a fertilized egg cannot be transplanted into the uterus once implanted outside of it, an ectopic pregnancy must be terminated to prevent life threatening complications to the mother. If the pregnancy is not far along, and the embryo is still small, the drug methotrexate is injected into the mother to end the pregnancy. This stops the embryo from growing, and it is reabsorbed into the mother’s body. Side effects of this treatment may include cramping, bleeding, nausea, vomiting, and diarrhea.

If the pregnancy is further along, 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 naval, hopefully 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 recuperation time. If the mother has extensive scar tissue in the abdomen or the embryo has grown larger, abdominal surgery in which the abdomen is opened and the embryo is removed may be necessary. Since this is major surgery, it requires much more time to heal.

The good news is that women who have had ectopic pregnancies have a good chance — approximately 85-90% — of developing normal pregnancies later. Of course, if there is damage, a medical professional will need to monitor any subsequent pregnancies closely. Since an ectopic pregnancy is a physical and emotional loss, those experiencing it should seek the emotional and spiritual support they need to deal with it.

An ectopic pregnancy may require emergency surgery.
An ectopic pregnancy may require emergency surgery.

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Discussion Comments

anon319733

Is it possible to test negative on a HCG blood test due to an ectopic or abdominal pregnancy? I have all pregnancy symptoms; nausea, extreme fatigue, tender breasts, and "fetal movement" but two blood tests over the course of a month have come out negative. I am so confused and scared.

anon266448

Please do not forget that there is a surgical procedure conducted by Wallace in 1917 (yes, 1917?) that will give the baby a chance to live.

This technique involves the removal of a live embryo from the ectopic location and position him or her into the uterus. If there is a tiny little chance of saving the baby and ensuring the well being of the mother as well because there is no need to remove the tube, why not trying? This is worth it and we should be talking much more about it and researching to improve the technique!

anon146952

the rate of maternal death in North America is only 0.l percent. While the fetus cannot survive, a mother is most likely to, provided she seeks immediate medical care.

anon113321

i have an abdominal pregnancy and post term and alive. i have not found a doctor to help me.

Kamchatka

@win199 - I do, actually, have information on ectopic pregnancy causes and symptoms. It's really scary, I had one a while back because I had an IUD in. I have had bad experiences with IUD's despite their rave reviews and won't be going back down that path again. Basically it's because there is a foreign object in your uterus that the egg doesn't want to attach to the wall. IUD's can also cause scar tissue and such from bumping up against your uterine wall as well.

win199

@Kamchatka - It also says that an IUD can increase the chance of having a tubal ectopic pregnancy. Do you have any information on that?

Kamchatka

Ectopic pregnancies, as mentioned above, can be life-threatening and there is a very slim chance that you or your baby will survive. It can be very scary. Ectopic pregnancy is a risk that many women take when they tie their tubes. Signs of ectopic pregnancy can include painful cramps off to the side of your normal uterine placement.

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