Understanding Ectopic Pregnancies

Leann Clink BSN, RN

Ectopic pregnancies are a life-threatening medical condition that can occur in the first trimester and requires immediate medical care. Know your risks, how to limit them, and what signs and symptoms to look for. Treatment for ectopic pregnancies are NOT affected or limited by abortion regulations. 

What is an Ectopic pregnancy?

An ectopic pregnancy is any pregnancy that is outside a woman’s uterus. It is also known as a tubal pregnancy. An ectopic pregnancy is when a fertilized egg does not travel through the fallopian tube to the uterus but instead attaches to the fallopian tube, ovary, the cervix or even in the abdomen.

How often does an ectopic pregnancy occur?

This can be difficult to measure but, according to one research study and the American Academy of Family Physicians, ectopic pregnancies can be as common as 1 in 50 pregnancies. Studies have shown that an ectopic pregnancy is the cause of bleeding and/or pain in the first trimester for between 6% and 16% of women’s emergency room visits. There are certain risk factors that can increase or decrease the risk of ectopic pregnancies. An ectopic pregnancy is a true medical emergency and can be life threatening to the mother if the fallopian tube ruptures. Unfortunately, this type of pregnancy means that the baby is not “viable” (won’t survive) because the placenta will not be able to attach in a way that can supply the baby with the needed blood and nourishment throughout the pregnancy. An ectopic pregnancy is the primary cause of pregnancy death in the first trimester for women.

What signs and symptoms would a woman with an ectopic pregnancy have?

An ectopic pregnancy will have a positive pregnancy test and in most cases, it will increase at the same rate as an IUP (intrauterine pregnancy). In rare cases, the pregnancy hormones rise at a slightly slower rate. Other signs or symptoms would include abnormal vaginal bleeding; low back pain; shoulder, neck or rectum pain (from internal bleeding); weakness; dizziness; fainting; and sudden, severe or one-sided abdominal pain. Ultrasound results will show no gestational sac or yolk sac, but a woman will have an HCG level of over 1,500.

What are the treatments for an ectopic pregnancy?

There are primarily two ways to treat an ectopic pregnancy. A woman may have to undergo surgery or take medications. If surgery is performed, the fallopian tube may sometimes be saved but not always. Unfortunately, the baby will not survive the surgery but this is a consequence of ectopic pregnancies, not the intention for the procedure. If your doctor recommends medication, methotrexate will be used. Methotrexate will cause the pregnancy to stop growing, and the body will then absorb the pregnancy over the next 4-6 weeks. Sometimes a second dose is needed. This non-invasive option ensures that the fallopian tube is preserved. Either option would require the woman to receive follow-up care over a 4-to-6-week period. If choosing medication, pregnancy prevention for 3 to 4 months is recommended as methotrexate can cause birth defects in a pregnancy during that time. As part of the treatment for an ectopic pregnancy, it is important for a woman to know her blood type, as negative blood types typically require a dose of RhoGAM.

Do abortion restrictions affect my treatment for an ectopic pregnancy?

Many women have this concern in light of Roe v. Wade falling and talk of further abortion regulations across the nation. There is a lot of misinformation regarding the treatment of ectopic pregnancies, and it is crucial that women understand their rights. In an abortion, the intention of surgical or pharmaceutical (administration of Mifeprex and Cytotec) action is to terminate a viable pregnancy. In an ectopic pregnancy, the pregnancy is non-viable. Therefore, the intention is not to terminate the pregnancy but to remove the affected area (typically fallopian tubes) or prevent them from rupturing due to the fetus’ location. The intention is to save the life of a mother as opposed to terminating a viable pregnancy. Instead, treatment is to save the mother from a life-threatening non-viable pregnancy. Abortion restrictions do not affect this life-saving treatment. The medical procedure used for abortions can be used for multiple reproductive health situations, but with a different intention. Roe v. Wade did not grant doctors permission to treat life-threatening ectopic pregnancies, so the overturning of this decision does not remove or restrict access to this treatment for women.

Who would be at risk for an ectopic pregnancy?

Many women with an ectopic pregnancy do not have any known risk factors, but certain factors do increase the likelihood of occurrence. These would include being over the age of 35, having a previous ectopic pregnancy, having fertility treatments like IVF (in vitro fertilization) and/or smoking. Using an IUD (intrauterine device) is very effective as a form of birth control but if it fails there is an increased likelihood of that pregnancy being ectopic. If a woman has had surgery on her fallopian tubes, either having tubes tied or tubes reconnected, that would increase her likelihood of a tubal pregnancy. The last major risk factor would be inflammation or infection such as from chlamydia or other STIs (sexually transmitted infections), as well as pelvic inflammatory disease.

How is an ectopic pregnancy diagnosed?

Diagnosing an ectopic pregnancy can be difficult since the early signs and symptoms are so similar to other medical diagnoses. A transvaginal ultrasound can sometimes determine if the pregnancy is in utero or not.  Analyzing beta hCG levels can also be an important indication of ectopic pregnancies. Beta hCG levels will increase if the pregnancy is in utero or if it is outside the uterus. However, if the pregnancy is outside the uterus the beta hCG levels may rise at a slower rate (often not doubling in 48 hours). An ectopic pregnancy may also be diagnosed with a manual pelvic exam. If time allows, some physicians may also choose to perform laparoscopic surgery to determine an ectopic pregnancy. Often, it is not possible to see an ectopic pregnancy with ultrasound and the diagnosis is considered when the pregnancy is not seen in the uterus when specific levels of hCG are also present. An ectopic pregnancy is usually diagnosed between 5 weeks and 12 weeks.

Will a woman grieve after an ectopic pregnancy?

Having an ectopic pregnancy will affect a woman’s physical health, emotional health, and even current relationships. Fear of future fertility loss and pregnancy can often occur. Some of the feelings a woman may experience are sadness, anger, self-blame, guilt, and depression. These are a natural part of the grieving process. It is important to acknowledge and express grief for both partners in the relationship. While men do not experience the physical effects or potential complications of an ectopic pregnancy, they do grieve. He may experience fear for his partner’s physical health and may want and need to express his grief. Grief will look different for women and their partner following an ectopic pregnancy. It is important for both people, if possible, to talk and work through their experience together.

Can a woman prevent an ectopic pregnancy?

While there is no way to completely prevent an ectopic pregnancy, there are things a woman can do to reduce her risk. By limiting the number of sexual partners or having only one partner for a lifetime, a woman can limit or eliminate her risk of sexually transmitted disease as well as the risk of pelvic inflammatory disease. Preventing sexually transmitted disease is helpful in reducing the risk for ectopic pregnancy. When women stop smoking and limit second hand smoke before trying to get pregnant, their risk for ectopic pregnancy also decreases. 

What happens after an ectopic/can life happen after?

Recovering physically and emotionally after an ectopic pregnancy takes time. It is recommended to wait at least 3 months after taking methotrexate and 2 menstrual cycles after surgery before trying to conceive again. Since a woman’s body usually has two fallopian tubes, one ectopic pregnancy will typically leave one fallopian tube remaining.  The good news is that close to 65% of pregnancies after an ectopic pregnancy successfully go to term with a healthy pregnancy. If a woman has had more than one ectopic pregnancy, she may need to seek the help of a specialist to become pregnant again or even use IVF. Some women may want to seek out the help of a counselor in processing their experience. Ob/gyn’s can provide local recommendations. Support groups through organizations like RESOLVE or SHARE are also helpful options for some women.