Rates of incidence of ectopic pregnancies have increased steadily over the past 50 years to an estimated 1% to 2% of all pregnancies. This condition is a leading cause of serious pregnancy complications and is responsible for more than 75% of first-trimester maternal deaths. However, advances in diagnostic techniques and treatments have significantly improved outcomes.
Symptoms
Ectopic pregnancies may cause cramping on one or both sides of the lower abdominal area, shoulder pain, and/or weakness or dizziness, along with typical pregnancy symptoms, such as breast tenderness, nausea, and a missed period. Some women will have vaginal bleeding or spotting, and levels of the pregnancy hormone human chorionic gonadotropin (hCG) may rise more slowly than expected. 98% of ectopic pregnancies occur in the fallopian tube. If left untreated, an ectopic pregnancy can grow until it ruptures the fallopian tube, which will cause heavy internal bleeding in the abdomen and may lead to shock. Symptoms of a rupture include severe pain in the abdominal area, vaginal bleeding, dizziness, and fainting.
Diagnosis
Diagnosing an ectopic pregnancy can be challenging, as confirming the location of the embryo is not always clear-cut early in pregnancy. In addition to blood tests to check pregnancy hormone levels, your blood type, and blood count, your doctor may likely use transvaginal ultrasound to check whether the gestational sac is visible in the uterus.
HCG Levels
Your hCG levels may be tested to check the rate that the hormone is rising in your blood over time. In normal pregnancies, the hormone should double about every two days. It may indicate a problem with the pregnancy if the hCG levels are not increasing as expected, but this alone is not an indicator of an ectopic pregnancy.
Ultrasound
Ultrasound is used to determine the location of the embryo. If a uterine pregnancy is confirmed via ultrasound, then the chance of ectopic pregnancy is rare. Sometimes, it is too early to diagnose an ectopic pregnancy via ultrasound because the embryo and gestational sac are too small to be found. If that happens, the exam will have to be repeated later.
Laparoscopy
In urgent situations, a laparoscopy procedure will be done to provide diagnosis and treatment. This is done in an operating room as surgery. If an ectopic pregnancy is confirmed laparoscopically, the surgeon will most likely remove the embryo during the procedure.
Causes
In healthy pregnancies, the egg and sperm meet in the fallopian tube, form an embryo, and then travel to the uterus to implant and grow. In ectopic pregnancies, the embryo does not make it to the uterus and implants elsewhere. A common cause of ectopic pregnancy, specifically tubal pregnancy, is an abnormality of the fallopian tube. When there are blockages, inflammation, or misshapen areas in the fallopian tube, the embryo can get stuck and implant in the wrong place. Surgery or infection of the fallopian tube can result in damage to the female reproductive tract. Another suspected cause is hormonal imbalance, specifically of estrogen. Abnormalities of the embryo may also be at play. Still, much remains unknown about how, why, and when ectopic pregnancy occurs. However, researchers have identified multiple risk factors that often accompany this condition.
Risk Factors
A person with an ectopic pregnancy does not always have identifiable risk factors, but some known risk factors include the following:
Birth defects of the fallopian tubesDouchingEndometriosisHistory of infertilityHistory of sexually transmitted infection (STI), specifically chlamydiaIn vitro fertilizationPelvic inflammatory diseasePrevious ectopic pregnancyProgestin-only birth control pillsScarring to the fallopian tubes (possibly from a ruptured appendix or previous pelvic surgery)SmokingTubal sterilization (or reversal)Use of an IUD
Among women using in vitro fertilization, the rates of ectopic pregnancy are increased by 2.5 to 5 times the incidence in natural conceptions. Rates are also heightened among historically underserved populations, including those on Medicaid and people of color.
When to Call the Doctor
If you are concerned about ectopic pregnancy but are not having symptoms of a rupture, call your practitioner as soon as possible for advice. If you have any symptoms of a possible rupture, head to an emergency room immediately.
Treatment
There are two main types of treatment for ectopic pregnancies: chemical and surgical. Treatment options will depend on where in the body the embryo has implanted as well as how far along the ectopic pregnancy has developed.
Low back painSudden, severe abdominal or pelvic painPain in the shouldersFainting or dizziness
Medical Management
Chemical treatment is done with a drug called methotrexate. It is used in non-urgent cases that are not at risk of rupturing. Methotrexate is given by injection and causes the ectopic pregnancy to stop growing, without harming the tubes and other organs. Over the next few weeks, the tissue will be absorbed by the body. Blood tests to measure levels of hCG, which is a hormone found only in pregnancy, can determine if further treatment is not needed. You will be closely monitored with blood tests until hCG levels have returned to zero in order to be sure that the pregnancy tissue has been completely absorbed.
Surgical Intervention
If an ectopic pregnancy is at risk of rupturing or has already ruptured the fallopian tube, this situation is life-threatening. The treatment for these cases is surgery to remove the embryo. Surgery is also usually done if the pregnancy is further along or there is another medical reason to not use the chemical treatment. If bleeding can’t be stopped, more extensive surgery is required.
Coping
Grieving an ectopic pregnancy is a little different from other forms of miscarriage. As well as losing your baby, with ectopic pregnancy, you are also dealing with the fallout of experiencing a potentially life-threatening condition and the possible impact on your future fertility. Be sure to give yourself time to cope emotionally as you heal physically. Some women may struggle with the idea that the baby may have been developing normally and had a heartbeat at the time of the surgery. Even though you may understand that the baby could have never survived to term, it’s understandable to have mixed feelings about having to terminate. You might encounter comments that seem to minimize your loss, such as, “just be glad they caught it in time.” Usually, people mean well. However, it is often hard for them to know how you feel and/or understand how you may receive their comments. Finding a support group or talking to a counselor can help.
Future Fertility
Once your recovery is physically underway, you may wonder about your ability to have a successful pregnancy in the future. If your fallopian tubes were not damaged, you have excellent chances of getting pregnant again, although there is a higher than average risk of having another ectopic pregnancy. If your tubes were damaged or removed, you still have pregnancy options, so consult your doctor. Additionally, it is recommended to wait at least three months after treatment to conceive again to make sure that your body is fully healed and that any medication (if used) is completely out of your system. However, if you do get pregnant before that timeframe, in many cases, the pregnancy may be healthy. Stay in touch with your doctor if or when you decide to try to conceive again. Research shows that between 10% and 27% of women will have a repeat ectopic pregnancy, making early prenatal care and close monitoring essential. Your doctor will likely advise you to come in early for a checkup in your next pregnancy to be sure that the pregnancy is developing in your uterus.
A Word From Verywell
The discovery of an ectopic pregnancy can be devastating, both because of the loss of the pregnancy and due to the possible impairment of your future fertility. If you’re hoping to conceive again, take time to grieve but also know that, in most cases, having a healthy pregnancy the next time around is very possible.
