One in every 60 pregnancies is ectopic, a word that means “out of place.” In an ectopic pregnancy, a fertilized egg attaches or implants itself somewhere other than in the uterus, usually inside one of the fallopian tubes (in which case it is also known as a tubal pregnancy), but occasionally in the cervix, ovaries, or abdomen. This sometimes happens because the movement of the egg through the fallopian tubes has been slowed or blocked by some external factor.
An ectopic pregnancy prevents the embryo from growing normally. Your doctor will be able to tell whether you’re experiencing an ectopic pregnancy by the 8th week of pregnancy.
Symptoms of Ectopic Pregnancy
There are many symptoms you can look for during the early stages of pregnancy that are tell-tell signs of an ectopic or abnormal pregnancy. Vaginal bleeding, whether it’s heavier or lighter than your normal menstrual cycle, can be a sign that something is wrong—although it can also cause an ectopic pregnancy to be mistaken for a miscarriage. Low progesterone and hCG levels are also serious indicators that something is wrong. Other symptoms may include:
- Pain while urinating or having a bowel movement
- Sharp pains in the abdomen
- Weakness
- Dizziness and fainting
- Lower back pain
- Cramping on one side
- Normal early pregnancy symptoms such as breast tenderness or nausea
If you are having any of these these symptoms, you should contact a physician immediately. If the affected area ruptures and begins to bleed, you may experience additional symptoms, including:
- An intense feeling of pressure in your rectum
- Shoulder pain
- Low blood pressure
- Sudden, severe pain in the lower part of your abdomen
Complications of Ectopic Pregnancy
An ectopic pregnancy has no chance of progressing normally and leading to the birth of a baby. The egg cannot survive outside the environment of the uterus, and before it dies its growth has the potential to cause permanent harm to the mother’s reproductive organs. If this condition is left untreated, it can even cause a fallopian tube rupture, leading to blood loss severe enough to threaten the mother’s life.
In rare cases, an ectopic pregnancy may occur concurrently with a normal, potentially viable pregnancy. This potentially dangerous condition is known as heterotopic pregnancy.
Who’s at Risk for Ectopic Pregnancy?
Women who are in their mid thirties to early forties are at a higher risk of a tubal pregnancy. If a woman has had a hysterectomy, has been diagnosed with PID (pelvic inflammatory disease) or has had any form of pelvic or abdominal surgery, her chances of having an ectopic pregnancy are much greater. Other risk factors include:
- Previous ectopic pregnancy
- Being over the age of 35
- Infection in the uterus or fallopian tubes, such as may be caused by gonorrhea or chlamydia
- Unusually shaped fallopian tubes
- Tubal ligation and IUD: conception in women who are employing either of these contraceptive devices is rare, but if it occurs there is an increased risk that it will be ectopic
- Surgery to reverse tubal ligation
Causes of Ectopic Pregnancy
Some research suggests a link between certain fertility drugs and ectopic pregnancy, but this has not been proven. Other possible causes of an ectopic pregnancy include:
- Congenital defect in the mother’s fallopian tubes
- Endometriosis
- Uterine scarring, such as may occur with Asherman’s Syndrome
Diagnosis and Treatment of Ectopic Pregnancy
To diagnose a tubal pregnancy, your doctor will need to conduct a variety of tests, including pregnancy blood tests and ultrasound. Blood tests will determine whether the hCG hormone is pregnant, which indicates that conception has occurred. If conception has occurred, ultrasound will enable the doctor to determine whether the fertilized egg has implanted in the wrong place.
There are various ways to treat an ectopic or tubal pregnancy. If the condition is diagnosed early enough, a drug known as methotrexate can be administered to stop the growth of the ectopic tissue and dissolve the cells that have already formed. After this injection the patient’s hCG levels will be monitored, and an additional methotrexate injection may be considered if those levels remain high.
Laparoscopic surgery is another option. Using a laparoscope, the doctor removes the ectopic pregnancy and either repairs or removes the fallopian tubes. If the fallopian tube has ruptured, it will be considered an emergency, and the tube will probably need to be removed entirely. In this case, a laparotomy will need to be performed; this surgery involves making an incision directly in the abdomen to remove the ectopic pregnancy tissue.
Prognosis Following an Ectopic Pregnancy
The occurrence of one ectopic pregnancy in a woman’s life unfortunately means an increased likelihood that it will happen in the future. In many other cases, the woman is never able to get pregnant again, although 33 percent of women who have had tubal pregnancies are eventually able to have babies.