A Closer Look at Ectopic Pregnancy

Ectopic pregnancy is the implantation of a fertilized egg outside the uterus. This most often occurs in a fallopian tube, which is a tube that connects the ovary to the uterus. Ectopic pregnancies occur in about 1–2% of pregnancies in the United States. Among people who become pregnant through assisted reproductive technology, the rate can be as high as 2–5%.

Rupture of an ectopic pregnancy is a potentially life threatening condition. Seek immediate medical care for serious symptoms, such as bleeding, fainting, intense rectal pressure, shoulder pain, or severe lower abdominal pain if pregnancy is confirmed or possible.

This article will provide an overview of ectopic pregnancy, including symptoms and risk factors. It will also discuss how doctors treat ectopic pregnancy and coping tips following an ectopic pregnancy.

An ectopic pregnancy happens when a fertilized egg implants in a location other than the uterus. Most often, this implantation occurs in a fallopian tube.

Initial symptoms of an ectopic pregnancy may feel similar to those of a typical pregnancy. However, as the ectopic pregnancy develops, more serious symptoms may occur.

• mild abdominal pain
• mild cramping on one side of the pelvic area
• lower back pain
• unusual vaginal bleeding

A ruptured ectopic pregnancy is a medical emergency that requires immediate treatment. Internal bleeding can cause serious complications that may become fatal.

If you are pregnant or may be pregnant, go to the emergency room or call 911 for symptoms including:

• sudden, intense pain in your pelvic area or abdomen
• shoulder pain
• dizziness
• fainting
• muscle weakness

Other serious symptoms could include:

• vomiting
• diarrhea
• urinary symptoms
• pain when passing stool

Learn about nine symptoms never to ignore if you are pregnant.

More than 90% of ectopic pregnancies happen in a fallopian tube. The cause often results from issues within the fallopian tube that prevent the fertilized egg from traveling to the uterus.

Conditions that can cause changes in fallopian tube function include:

• congenital irregularities in the structure of the fallopian tube
• endometriosis, which is a condition that causes the growth of uterine tissue outside the uterus
• scarring from previous pelvic or abdominal surgeries, such as tubal ligation or appendectomy
• tissue damage and scarring from previous infections, such as chlamydia or pelvic inflammatory disease
• salpingitis, which describes the inflammation of the fallopian tube that may result from several factors

A number of factors increase the risk of developing an ectopic pregnancy. Not all people with risk factors will have an ectopic pregnancy, and not everyone who has an ectopic pregnancy has risk factors.

In addition to issues that affect the fallopian tubes, risk factors for ectopic pregnancy include:

• being over 35 years old
• having previously experienced an ectopic pregnancy
• becoming pregnant while using an intrauterine device
• becoming pregnant with assisted reproductive technology, such as in vitro fertilization
• smoking, which may damage the tiny, hair-like membranes in the fallopian tubes, called cilia, that push the egg toward the uterus

Talk with your OB-GYN about your individual risk factors for ectopic pregnancy. Together, you can work to manage your risk in the context of your personal reproductive goals.

Learn about nine things doctors want you to know about high risk pregnancies.

If you do not have emergency symptoms of a ruptured ectopic pregnancy, your OB-GYN will evaluate your symptoms to determine if you may have an ectopic pregnancy. To do this, they will take your medical history, perform a pelvic exam, and order diagnostic tests.

These tests will likely include checking your levels of human chorionic gonadotropin (hCG), which is the hormone that clinicians measure in a pregnancy test. Low levels of hCG and progesterone may indicate that a pregnancy is not developing as it should.

You may also undergo a transvaginal ultrasound to determine if or where a fetus is developing.

Learn about 15 things your OB-GYN wants you to know if you are pregnant.

Treatment for an ectopic pregnancy always involves ending the pregnancy. Pregnancy in a fallopian tube cannot continue because it will risk the life of the pregnant person.

Doctors can treat an ectopic pregnancy with the following methods.

In cases when the pregnant person is stable and there is no sign of a rupture, doctors may administer an injected medication called methotrexate. Methotrexate encourages the absorption of the pregnancy tissue and preserves the fallopian tube.

Doctors will first confirm that the pregnancy is ectopic — and not in the uterus — and that the person meets the guidelines for receiving methotrexate.

Your OB-GYN will monitor the levels of hCG in your blood. If hCG is not dropping to levels that indicate that the pregnancy has ended, they may need to administer additional methotrexate.

Surgery may be necessary if severe symptoms develop. These include signs of internal bleeding, persistent intense pain, or any instability in the pregnant person.

Surgery to treat ectopic pregnancy involves the removal of the pregnancy. Doctors may remove the ectopic pregnancy from the fallopian tube or remove the entire tube with the pregnancy.

Most often, this is a laparoscopic procedure that involves an incision through the stomach. In more severe cases, doctors may need to perform a laparotomy, which involves open abdominal surgery.

In rare cases, doctors may suspect an ectopic pregnancy in someone who does not have physical symptoms. This may be due to blood tests that show low or decreasing hCG levels in someone who may be pregnant.

In these situations, doctors may advise watchful waiting to see if symptoms develop or if the pregnancy naturally absorbs into the fallopian tube.

An ectopic pregnancy can be an emotional and even traumatic experience, particularly if you have a rupture. You may need time for both physical and emotional recovery.

Grieving the loss of your pregnancy can take several months. It is important to seek support from those around you as you work through your loss.

Steps to help cope with recovery after an ectopic pregnancy include the following:

• If you feel comfortable, talk with friends and loved ones about what you are experiencing, and accept help when others offer it.
• Talk with your OB-GYN about how you are feeling, both physically and emotionally. They can guide you toward the resources available in your area.
• Seek out support groups, either online or in person. Discussing your emotions and concerns with others who share your experience can provide comfort.
• Ask your doctor for a referral to a counselor or another mental health professional who has training in grief counseling.

These are some other questions people often ask about ectopic pregnancy. The answers have been reviewed by Dr. Wendy Satmary, M.D., FACOG.

Symptoms of an ectopic pregnancy usually occur some time in the first trimester, between weeks 4 and 12 of gestation.

Once a doctor diagnoses an ectopic pregnancy, immediate treatment is necessary to end the pregnancy. Further development of the fertilized egg can cause a rupture, which is a potentially life threatening condition for the pregnant person.

No. Because the fallopian tube is not meant to grow a pregnancy, the embryo cannot develop properly. It is also not possible to move an ectopic pregnancy into the uterus.

An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the uterus. Most often, ectopic pregnancy happens in a fallopian tube.

In some cases, an ectopic pregnancy can rupture. This is a medical emergency that requires emergency treatment to protect the life of the pregnant person.

All treatment of ectopic pregnancy results in the loss of the pregnancy. Your OB-GYN can provide guidance on support resources during your physical and emotional recovery from an ectopic pregnancy.