Ectopic pregnancy
Pregnancy starts when a fertilized egg implants in the inner lining of the uterus. However, fertilized eggs can also accidentally implant in other parts of the abdomen. When this happens, it is called an ectopic pregnancy.
Most often, fertilized eggs implant in the fallopian tube, which connects the uterus and ovaries. This is sometimes referred to as a tubal pregnancy.
What are the causes and risk factors for an ectopic pregnancy?
Normally, eggs are fertilized in the fallopian tubes and then move down into the uterus. However, if the fallopian tubes have been damaged by infection, scar tissue or tubal ligation (sterilization), the egg can get stuck and start developing there.
Sometimes, birth defects or medical conditions that affect the shape of your reproductive organs can cause an ectopic pregnancy. Hormonal imbalances can also play a role in ectopic pregnancies.
Additional risk factors for ectopic pregnancy include:
- Conceiving while using a contraceptive device like an intrauterine device (IUD) or after a tubal surgery.
- Conceiving at an older age.
- Having a previous ectopic pregnancy.
- Having a sexually transmitted infection (STI), which can cause inflammation and scarring.
- Having endometriosis; this is when cells that resemble uterine cells grow outside the uterus, usually on other organs in the pelvis. Endometriosis can often lead to scarring and adhesions that block the egg’s path to the uterus.
- Having pelvic inflammatory disease (PID), which can also lead to scarring and tissue damage.
- Having trouble getting pregnant, using fertility drugs or having a fertility treatment like in vitro fertilization (IVF) to conceive.
- Smoking.
What are the symptoms of an ectopic pregnancy?
Early warning signs
Usually, the first symptom of an ectopic pregnancy is light bleeding or spotting. This bleeding can sometimes be confused with intermenstrual bleeding or implantation bleeding. However, if blood is coming from the fallopian tubes, it is often also accompanied by shoulder pain and the urge to have a bowel movement.
If you have these symptoms, speak with your healthcare provider. Symptoms usually appear 2 to 4 weeks after a missed period, or after 6 to 10 weeks of pregnancy. However, symptoms can start as early as four weeks after conception.
Ectopic pregnancies and pregnancy tests. Pregnancy tests usually detect ectopic pregnancies. This is because the fertilized egg starts releasing a specific pregnancy hormone, called human chorionic gonadotropin (hCG), regardless of where it implants. It is this hormone that pregnancy tests detect.
Symptoms
Some ectopic pregnancies occur with few to no symptoms, or symptoms that appear ‘normal.’
In many cases, ectopic pregnancy symptoms can overlap with intrauterine pregnancy (pregnancy that happens in the uterus) symptoms. They include:
- Breast soreness.
- Missed period (if periods are regular).
- Nausea.
However, unlike a normal pregnancy, ectopic pregnancies also cause:
- Belly (abdominal) and pelvic pain, which is often sharp or stabbing and comes in waves.
- Dizziness, weakness or fainting.
- Fever.
- Shoulder pain, often at the tip of the shoulder or in the shoulder blade.
- Neck pain.
- Pain on one side of the body.
- Red or brown vaginal bleeding or spotting. This may be accompanied by rectal, shoulder or abdominal pain.
- Urge to have a bowel movement or feeling rectal pressure.
- Vomiting.
These symptoms do not always mean you have an ectopic pregnancy, but they can be the signs of another serious medical condition.
No matter what, if you experience these symptoms, seek immediate medical attention.
How is an ectopic pregnancy diagnosed?
If you suspect you may have an ectopic pregnancy, seek medical attention immediately.
Diagnostic tests
Your healthcare provider will draw some blood and test it for hCG levels. In a normal pregnancy, hCG levels usually double every few days during the first weeks of pregnancy. However, with an ectopic pregnancy, hCG levels may rise more slowly or plateau. Your doctor may redraw your blood a few days after your first assessment, especially if the pregnancy is early on.
Your healthcare provider will also perform a transvaginal ultrasound, which involves inserting an ultrasound wand into the vagina. The scan allows your doctor to see whether there is a gestational sac in the uterus or not. If there is no gestational sac but hCG levels are elevated, this may indicate an ectopic pregnancy. Additionally, your doctor may perform an ultrasound to assess whether there is a visible mass in your fallopian tubes.
Note that if your symptoms are severe, there may be no time to go through all of these steps. Your doctor may need to perform emergency surgery to stop any internal bleeding and remove the ectopic pregnancy.
How is an ectopic pregnancy treated?
There are several treatments for an ectopic pregnancy. Treatment largely depends on whether the fallopian tube has ruptured and how far along the pregnancy is.
Methotrexate. For an early ectopic pregnancy with only minor bleeding, your doctor may give you an injection of a medication called methotrexate. This medication stops rapidly growing cells (like those of a fertilized egg) and dissolves existing egg cells. Over the next few days, your doctor will check your hCG levels to make sure that the medication is working.
Methotrexate has a low risk of causing permanent damage to the fallopian tubes. However, you will not be able to conceive for a few months after the treatment.
Laparoscopic surgery. Laparoscopic surgery is a minimally invasive surgical procedure. Your surgeon makes a small incision in your abdomen and inserts a small tube with a light and camera. This allows your surgeon to see the tube and remove the ectopic tissue. In some instances, the surgeon can allow the fallopian tube to heal on its own. In others, your surgeon must remove the entire fallopian tube. The type of surgery depends on whether the fallopian tube appears relatively normal or shows signs of damage.
Emergency surgery. If your symptoms are severe and you are experiencing internal bleeding, you may need emergency surgery. Your surgeon makes a larger incision in your abdomen and then works to stop internal bleeding and remove the ectopic tissue. Sometimes, the fallopian tube can be saved. But more often, it has ruptured and is damaged beyond repair.
Recovering from an ectopic pregnancy
After medication
If you were treated with methotrexate, you will have to return to your doctor after a few days to make sure that the treatment is working. Be sure to rest and drink plenty of fluids during this time. You can expect some vaginal bleeding and cramping following treatment, but these should resolve shortly. You will not be able to conceive for a few months after treatment. Be sure to talk to your doctor before trying to get pregnant again.
After surgery
If you require emergency surgery for an ectopic pregnancy, you may need to stay in the hospital. Afterward, your doctor will give you specific instructions on how to take care of yourself and your incision. Be sure to keep your incision dry and clean following surgery and watch for signs of infection, like redness or pain around the wound.
You can expect to have some vaginal bleeding and pain. These should resolve within 6 weeks of your surgery. You should also engage in pelvic rest for a few weeks after your surgery. This means avoiding tampons, sexual intercourse, douching or inserting objects into your vagina.
Many experts recommend that you give your body three to six months to heal entirely before trying to conceive again.
Getting emotional support
An ectopic pregnancy can be a very upsetting and traumatic experience. Give yourself time to process and grieve.
If you feel comfortable, you may want to reach out to your family and friends for support during this time. There are also support groups for people who have experienced ectopic pregnancies.
You may also want to consider individual therapy and mental health support. A mental health professional can help guide you through the healing process.
Can you get pregnant after an ectopic pregnancy?
In many cases, you can have a healthy pregnancy after having an ectopic pregnancy. The female reproductive system has two fallopian tubes. If one is damaged or removed, fertilization can happen in the other, and the fertilized egg can travel to the uterus.
If both fallopian tubes have been damaged or removed, you may want to consider in vitro fertilization. In this procedure, your egg is fertilized externally and then implanted into the uterus.
Note that having one ectopic pregnancy increases your risk of having another. If you decide to get pregnant again, be sure to talk to your doctor about your risks and options.
If you do become pregnant, you should see your doctor as soon as possible to get an ultrasound and blood tests to make sure the pregnancy is healthy.
FAQs about ectopic pregnancies
How common are ectopic pregnancies?
According to the American College of Obstetricians and Gynecologists (ACOG), ectopic pregnancies account for about 2% of all pregnancies in the United States.
Can you have an ectopic pregnancy even after a successful pregnancy?
Yes, it is possible to have an ectopic pregnancy even if you’ve had a successful pregnancy before. Having a history of ectopic pregnancy increases the risk of having another one in the future.
How early can an ectopic pregnancy be detected?
Ectopic pregnancies are commonly detected during the early stages of pregnancy, with healthcare providers often diagnosing them within the first trimester of pregnancy through blood tests and ultrasounds.
Can an ectopic pregnancy be saved?
Unfortunately, an ectopic pregnancy is not viable, and it’s not possible for the pregnancy to continue. Once the fertilized egg implants outside the uterus, it cannot be relocated to the uterus. Swift treatment for an ectopic pregnancy is crucial, as a ruptured fallopian tube can lead to significant internal bleeding and be potentially life threatening for the mother.
What causes an ectopic pregnancy?
Ectopic pregnancies usually occur when the fallopian tube is damaged or blocked, preventing the fertilized egg from reaching the uterus. Common causes include previous fallopian tube infections, pelvic inflammatory disease, endometriosis, previous abdominal surgery or abnormalities in the fallopian tubes.
Are there ways to prevent an ectopic pregnancy?
You can’t directly prevent an ectopic pregnancy, but you can reduce the risk of one by adopting healthy lifestyle habits. These include maintaining a healthy weight, not smoking, practicing safe sex to prevent sexually transmitted infections, promptly treating any pelvic infections and seeking early medical attention if you suspect you might be pregnant and experience abdominal pain or abnormal bleeding.
How long should you wait to try and become pregnant again after an ectopic pregnancy?
You should consult with your healthcare provider before trying to become pregnant again following an ectopic pregnancy in case there are lingering complications. However, under normal circumstances, most doctors recommend that you give your body at least 3 to 6 months to heal entirely before trying to conceive again. This allows time for your fallopian tubes to heal and reduces the likelihood of experiencing another ectopic pregnancy.
Why is shoulder pain common in ectopic pregnancies?
Shoulder pain is common in ectopic pregnancies due to a phenomenon known as referred pain. When an ectopic pregnancy causes internal bleeding or the fallopian tube ruptures, blood may irritate the diaphragm, which shares nerve pathways with the shoulder. This can lead to pain felt in the shoulder, even though the source of the problem is in the pelvic region. It is important to recognize shoulder pain along with other symptoms of ectopic pregnancy for prompt medical attention.
References
American College of Obstetricians and Gynecologists. Ectopic Pregnancy (https://www.acog.org/womens-health/faqs/ectopic-pregnancy)
National Center for Biotechnology Information (NCBI): National Library of Medicine. Ectopic Pregnancy (https://www.ncbi.nlm.nih.gov/books/NBK539860/)
American Academy of Family Physicians. Ectopic Pregnancy (https://www.aafp.org/pubs/afp/issues/2000/0215/p1080.html)