Five Important Questions and Answers about Ectopic Pregnancy
In light of recent confusion on the topic, here are the science-backed details you need to know.
Medical Expert Sources: Jill Purdie, MD, OB-GYN; Anna Whelan, MD, OB-GYN
If you’ve heard of ectopic pregnancy, it probably left you with some pressing questions. Ectopic means “out of place,” which is precisely what happens in these cases of conception: An ectopic pregnancy occurs when a fertilized egg (embryo) implants outside the uterus, typically in a fallopian tube. About 1 in every 50 pregnancies in the U.S. is an ectopic—or tubal—pregnancy. In rarer cases, the embryo attaches to an ovary, the cervix or the abdominal cavity. Sound concerning? Unfortunately, ectopic pregnancy is a serious condition that can lead to maternal death when left untreated.
As more U.S. states move to pass restrictions on abortion, there’s growing concern from health care experts and the public at large on whether potential regulations will permit pregnant women from safely accessing care for treatment of ectopic pregnancy. While ectopic pregnancy (and other emergency care scenarios) is typically included in anti-abortion legislation, the legislative language may be vague enough that providers fear offering treatments or may choose to delay care for an individual, which can be deadly.
The American College of Obstetricians and Gynecologists (ACOG) explains that, “Abortion bans—even those with exceptions for ectopic pregnancy—can generate confusion for patients and health care professionals and can result in delays to treatment. Health care professionals should never have to navigate vague legal or statutory language to determine whether the law allows them to exercise their professional judgment and provide evidence-based care.”
These poorly written state laws are dangerous and unethical. And while treating ectopic pregnancy as a whole is not technically banned, the threat to access of life-saving medications and timely care is certainly looming, especially for women living in states that have limited or banned abortions.
For example, a bill introduced by Missouri Rep. Brian Seitz (House Bill 2810) in March received outrage from the medical community after seeking to criminalize the production, distribution, and administering of drugs needed to perform abortions and treat ectopic pregnancy. The original bill also sought to make terminating an ectopic pregnancy illegal; this language was removed before the Missouri House committee approved the proposed bill that now states use of such drugs is a class B felony, punishable by five to 15 years in prison.
“This proposed law has no standing in medical science and threatens the lives of all pregnant patients,” Anna Whelan, MD, OB-GYN and maternal fetal medicine physician in Rhode Island, told Verywell in an interview. “Treatment of ectopic pregnancies and abortion care are simply not the same.”
With so much conversation surrounding ectopic pregnancy, it’s important you know the facts. Read on for more information, so you can eliminate confusion, spot the warning signs and most importantly, know how to get proper help.
1| How Dangerous is an Ectopic Pregnancy?
An ectopic pregnancy is a medical emergency, and should be handled with urgency, according to Jill Purdie, MD, OB-GYN and medical director at Northside Women’s Specialists, part of Pediatrix Medical Group in Atlanta, Georgia. “If an ectopic pregnancy is not treated in a timely manner, it can be life threatening to the mother. Since the ectopic pregnancy is not in the appropriate location, as it grows larger, the pregnancy sac can rupture, resulting in internal bleeding. This bleeding can be significant enough to result in death if not recognized and treated quickly,” she says.
A woman’s uterus is uniquely suited to support the growth of a developing baby thanks to its amazing ability to stretch and expand through pregnancy. Less-flexible fallopian tubes are unable to hold a growing fetus and are at risk for severe injury, which can complicate a woman’s future chances of getting pregnant as easily.
2| What are the Symptoms of Ectopic Pregnancy?
An ectopic pregnancy may start out with typical early pregnancy symptoms, such as a missed period, nausea or breast tenderness. However, there are telltale warning signs that something isn’t right. “The most common symptoms of ectopic pregnancy are bleeding and pelvic pain, especially one-sided pain. Women should see their physicians early in pregnancy (typically within the first eight weeks) if they are experiencing these symptoms,” explains Dr. Purdie.
In addition to pelvic pain and vaginal bleeding, call your healthcare provider right away if you’re feeling faint or dizzy (which could signal low blood pressure), or if you’re experiencing pain in the lower back or shoulder. While these clues may seem vague, it’s always important to take them seriously and get checked out as soon as possible.
Women should also know that there is no known cause of ectopic pregnancy, and more than half of cases will have no risk factors, according to Dr. Purdie. This means it can happen to anyone, even if you’ve had a history of healthy pregnancies. You may be at a higher risk for ectopic pregnancy if you’ve had previous pelvic or tubal surgery, prior pelvic inflammatory disease or chlamydial infections, a previous ectopic pregnancy or are a smoker.
To help minimize potential risk, Dr. Purdie encourages women to use appropriate protection to prevent infections, treat any infections in a timely manner and quit smoking, if applicable.
3| Can an Ectopic Pregnancy Continue After Diagnosis?
Sadly, an ectopic pregnancy is not considered viable “since extrauterine locations are not made to accommodate pregnancy, and the fetus cannot grow to the size of viability,” Dr. Purdie says. “The fetus also cannot be moved or reimplanted into the uterus from an external location.”
While we certainly hope for reproductive technology advances to make this a possibility for the future, it’s crucial that women know the scientific facts in order to receive vital and timely care, as ectopic pregnancy accounts for almost 3 percent of all pregnancy-related deaths.
It’s also important to note that treating ectopic pregnancy through termination is not the same as abortion care. Tubal pregnancies are always fatal for the fetus, and successful abdominal pregnancies are extremely rare, accounting only for up to 1.4 percent of all ectopic pregnancies.
4| How is Ectopic Pregnancy Treated?
Beforehand, a pelvic exam, urine test, blood test or ultrasound (or a combination) will be done to confirm a pregnancy is indeed ectopic. According to the March of Dimes, there are two primary treatment options available after diagnosis:
Your doctor administers an injection of the medication called methotrexate to stop further growth of the embryo. This option works best if the fertilized egg is small and located in the fallopian tube.
Your doctor surgically removes the embryo by making very small incisions to the abdomen. This type of procedure is called laparoscopic surgery.
Very rarely, a “wait and watch” approach is used if the fetus appears to be miscarrying and hCG levels are dropping. This is called a natural miscarriage. In most cases, ectopic pregnancies must be removed surgically.
After treatment, your provider will do regular follow-ups to check your hCG levels until they return to zero, signaling all ectopic tissue has been removed. This can take up to a few weeks.
5| What are the Chances of Having Another Ectopic Pregnancy?
According to the American College of Obstetricians and Gynecologists, a woman has about a 10 percent chance of a second ectopic pregnancy if she’s had one previously. “After two or more ectopic pregnancies, the risk goes up to 25 percent,” explains Dr. Purdie.
The good news is that most women go on to have healthy pregnancies later on. Even if one fallopian tube is damaged, or it has to be removed, your eggs can still travel down your remaining tube. In these cases, assisted fertility treatments called in vitro fertilization (IVF) may also be considered following an ectopic pregnancy.
Talk with your healthcare provider about any contributing factors after being treated for an ectopic pregnancy and follow their guidelines for lifestyle changes as well as a timeline for future conception. Together, you can make a plan to move forward toward your goals.