What is an Ectopic Pregnancy?

An ectopic pregnancy, also known as a “tubal” pregnancy, occurs when a fertilized egg is implanted outside of the uterus. Surprisingly, this occurs in one out of 50 pregnancies. Unfortunately, all end in termination of the pregnancy.

In a normal pregnancy, a fertilized egg makes its way down the Fallopian tubes to the uterus, where it will make its home for the next nine months. The problem occurs when the tubes are blocked or damaged and the egg cannot make it through. A rarer form of ectopic pregnancy occurs when an egg is implanted in the ovary, cervix, abdomen, or c-section scar. Even rarer is a heterotopic pregnancy, in which a woman who has a normal pregnancy experiences an ectopic one simultaneously. This is more likely to affect a woman undergoing fertility treatments.

An undiagnosed ectopic pregnancy is a serious complication that can result in damage to the Fallopian tube, or worse, Fallopian tube rupture, possibly causing permanent damage or loss of the tube. It can cause heavy bleeding and, in rare cases, death.

Women at higher risk for developing this type of pregnancy are those who become pregnant even though they have had a tubal ligation, surgery on the Fallopian tubes, pelvic or abdominal surgery, or removal of ovarian cysts or fibroids. Women who have had previous ectopic pregnancies are also at risk. Also at higher risk are women whose mothers took the drug diethylstilbestrol (DES), a synthetic form of estrogen used in the late 1960s to prevent miscarriage, while she was pregnant with them, and those who are taking a progestin only hormonal contraceptive.

Using an intrauterine device (IUD), which prevents implantation, can also increase the risk. Damage sustained to the Fallopian tubes from an infection of the upper reproductive tract caused by pelvic inflammatory disease (PID) can also be a risk factor. Other risk factors include age, smoking and the frequent use of douches.

Symptoms of ectopic pregnancy usually occur around the sixth or seventh week, which is when the general symptoms of pregnancy usually start. Some symptoms can be detected as early as four weeks, however. This type of pregnancy doesn't always trigger home pregnancy tests, so usually the complications alert the mother to the problem.

The most common symptom is abdominal tenderness and pain, usually on one side, but often non-localized. Often, there is vaginal bleeding or spotting, as well as increasing pain when coughing or going to the bathroom. Pain in the shoulder is often present and can signal a rupture, especially if the pain intensifies when lying down.

Because a fertilized egg cannot be transplanted into the uterus once implanted outside of it, an ectopic pregnancy must be terminated to prevent life threatening complications to the mother. If the pregnancy is not far along, and the embryo is still small, the drug methotrexate is injected into the mother to end the pregnancy. This stops the embryo from growing, and it is reabsorbed into the mother’s body. Side effects of this treatment may include cramping, bleeding, nausea, vomiting, and diarrhea.

If the pregnancy is further along, or if the mother is breastfeeding or bleeding internally, surgery may be the only option. In a laparoscopic surgery, the embryo is removed through a small cut in the naval, hopefully preserving the Fallopian tube. In some cases, if there is excessive bleeding or extensive damage, the tube must be removed. This requires general anesthesia and about a week of recuperation time. If the mother has extensive scar tissue in the abdomen or the embryo has grown larger, abdominal surgery in which the abdomen is opened and the embryo is removed may be necessary. Since this is major surgery, it requires much more time to heal.

The good news is that women who have had ectopic pregnancies have a good chance — approximately 85-90% — of developing normal pregnancies later. Of course, if there is damage, a medical professional will need to monitor any subsequent pregnancies closely. Since an ectopic pregnancy is a physical and emotional loss, those experiencing it should seek the emotional and spiritual support they need to deal with it.