What is an ectopic pregnancy?

Erica Robinson, MD

Gynecology

While pregnancy is a common aspect of life for many, there are complications that can arise that lead to injury or even life-threatening circumstances. One of those complications is when the pregnancy is ectopic. How are ectopic pregnancies detected and treated? Will an ectopic pregnancy affect future attempts to have children?

Gynecologist Erica F. Robinson, MD, explained what you need to know about ectopic pregnancies.

What is an ectopic pregnancy?

“Essentially, a pregnancy is ectopic when it is formed and found outside of the uterine cavity,” said Dr. Robinson. “The most common, and most well-known location for an ectopic pregnancy is within the fallopian tube, which is also referred to as a ‘tubal pregnancy.’ This represents more than 90% of ectopic pregnancies.”

While it happens more rarely, these pregnancies can also develop in locations like the cervix, the ovary itself, within prior C-section scars and even within the abdomen.

Why is an ectopic pregnancy dangerous?

“The fallopian tube simply cannot support a growing pregnancy,” said Dr. Robinson. “Only the uterus is designed to adapt to the developing fetus. Pregnancies within the fallopian tube or other locations outside of the uterus can be incredibly dangerous.”

The location of the pregnancy can be damaged by its attempts to grow and develop, and those pregnancies within the fallopian tube eventually result in a rupture (or will burst open) if left untreated. If this happens, the resulting internal bleeding can be life threatening without immediate emergency surgery.

Are there risk factors for ectopic pregnancy?

“Anything that causes a change to normal tubal anatomy can increase your risk,” said Dr. Robinson.

Factors that increase the risk of an ectopic pregnancy include:

• Prior ectopic pregnancies
• Prior STIs (sexually transmitted infections), including chlamydia or gonorrhea
• Prior pelvic inflammatory disease (PID)
• History of surgery on the fallopian tubes
• Endometriosis
• Some prior pelvic surgeries
• History of infertility, use of invitro fertilization (IVF) or other assisted reproductive technologies
• Being over the age of 35
• Use of tobacco products

Many women who develop an ectopic pregnancy, however, have no known risk factors.

What are the symptoms of ectopic pregnancy?

“Ectopic pregnancies start out feeling like any other pregnancy,” said Dr. Robinson. “Symptoms like breast tenderness, nausea, the need to urinate frequently and other early pregnancy symptoms can be normal. It’s really at around the six-to-eight-week gestation mark that an ectopic pregnancy shows the most telltale symptoms of pain and bleeding.”

Women with ectopic pregnancies may notice vaginal bleeding, with or without abdominal pain. As the fallopian tube is forced to stretch around the growing pregnancy, abdominal pain will usually be felt first between the sixth and seventh week. If the tube ruptures, the pain will be very abrupt, sharp and often severe. Sometimes the pain can be associated with nausea and vomiting.

Bleeding varies, and as vaginal bleeding can be common even in healthy pregnancies, it’s important to see your OB/GYN and let them know. Vaginal bleeding isn’t necessarily anything to worry about, but it’s best to know for sure.

How is an ectopic pregnancy diagnosed?

If the pregnancy is confirmed by hormone testing, but there is no sign of the developing pregnancy is found within the uterus, that’s when an obstetrician may become concerned about a possible ectopic pregnancy.

“Ectopic pregnancies aren’t the only reason for a PUL, or pregnancy of unknown location,” said Dr. Robinson. “It could just be that the pregnancy isn’t developed enough yet to be seen or could be due to an abnormal or ‘chemical pregnancy’.”

For some, doctors will advise keeping a close eye on pregnancy hormones for the telltale changes of a continuing pregnancy and repeat the ultrasound. Once the gestational sac and embryo (or yolk sac) are seen on the ultrasound outside of the uterus, an ectopic pregnancy is confirmed. However, sometimes ectopic pregnancies are not confirmed until the time of surgery, especially if a patient presents with severe pain and the physician suspects an ectopic pregnancy as the cause.

Can an ectopic pregnancy be moved?

“An ectopic pregnancy cannot be moved or transferred into the uterus,” said Dr. Robinson. “This is a persistent myth, but it just cannot be done.”

Ectopic pregnancies must be treated, and because of the danger of serious, life-threatening complications, treatment must happen within a short time frame.

How are ectopic pregnancies treated?

There are two methods for treating ectopic pregnancies: medical and surgical.

When treated with medication, a medicine called methotrexate is used to stop cells from growing, this in turn ends the pregnancy. Once there is no further growth, the mother’s body reabsorbs the pregnancy over time. This option is only available if there hasn’t been a rupture yet and there isn’t any concern about bleeding. There are other concerns and restrictions that you’ll need to discuss with your doctor.

The surgical option is generally more commonly known, and it’s dependent on how badly the fallopian tube or surrounding area has been damaged. This is also the only solution if the ectopic pregnancy has ruptured and there is internal bleeding. Surgery for ectopic pregnancy is designed to be minimally invasive, using small incisions with a shorter recovery time.

In areas where pregnancy termination is prohibited, what can a woman do to protect her health?

“Where access to termination is limited, my advice is for women to do what they can to prevent pregnancy in the first place,” Dr. Robinson said. “Long-acting reversible contraceptives, such as IUDs, tend to have the lowest failure rates with standard use, so they are considered to be some of the most reliable forms of birth control.”

However, even when everything is done correctly, pregnancy can still occur.

“This is why OB/GYNs tell their patients to seek medical attention if they have any symptoms of early pregnancy while they are using birth control,” Dr. Robinson added. “If a pregnancy occurs while using contraception, such as an IUD, that pregnancy is more likely to be ectopic.”

Does having an ectopic pregnancy affect future pregnancies?

“Having had an ectopic pregnancy does raise your risk for them in the future,” said Dr. Robinson. “But it doesn’t mean you won’t be able to carry a healthy pregnancy later.”

To become pregnant, you need one functioning fallopian tube and one functioning ovary, and they don’t even need to be on the same side. If you previously were treated for an ectopic pregnancy, stay very alert during the early weeks of gestation, and notify your OB/GYN as soon as you see a positive pregnancy test.

Just like with every pregnancy, it’s important to have a doctor you trust working with you to help your baby develop. In this case, you’ll want to work even more closely together with your doctor to be sure your pregnancy is right where it should be.