Understanding Ectopic Pregnancy

Pregnancy is one of the most transformative processes a human can go through. Whether it’s the birthing person, partner, or the baby itself. 

But creating a human from scratch is hard work, and far from straightforward. With conception, often comes complications. These complications range from frustrating, to annoying, to painful, to heartbreaking, and potentially life-threatening.

One possible complication is an ectopic pregnancy. You’ve probably heard this term before and may have a general idea of what it is, now we’re going to break it down even further.

What is an Ectopic Pregnancy?

An ectopic pregnancy is any pregnancy implanted outside of the endometrial cavity within the uterus. This is the leading cause of first trimester deaths amongst pregnant people, but is usually entirely treatable when caught early on, and may even resolve on its own.

About one in fifty pregnancies in the U.S. is considered “ectopic”.

Typically a fertilized egg will implant on the endometrium, aka the inner lining of the uterus. In the case of an ectopic pregnancy, the embryo actually implants outside of the uterine wall. 

They are sometimes called tubal pregnancies, since they most commonly occur in the fallopian tubes. However, implantation can also happen in the abdomen, the cervix, or an ovary.

Signs of an Ectopic Pregnancy

With your body undergoing so many changes, it can be hard to figure out what is and isn’t normal. Knowing what warning signs to look out for, can prevent any further complications.

In some cases, a pregnant person may not even know they are pregnant until they experience symptoms of an ectopic pregnancy.

Here’s what to look out for:

• Typical Signs of Pregnancy: Like missing a period (amenorrhea), nausea, breast tenderness, and nausea.
• Abdominal and Pelvic Pain: Especially if it is severe, or gradually worsening. 
• Excessive Bleeding or Hemorrhage: This could be indicative of a tubal rupture.
• Vaginal Bleeding or Spotting: Some spotting can be normal in pregnancy, but it could potentially be a sign of a tubal pregnancy.
• Dizziness: Low blood pressure from bleeding can cause faintness or dizziness.
• Nausea and Vomiting: Of course this can be a normal part of pregnancy, but it is something to watch out for, especially if it comes from out of the blue.
• Intense Shoulder Pain: Can occur if there is internal bleeding. 
• Shock: Symptoms of blood loss or internal bleeding like confusion, pale skin, change in pulse, or dizziness.
• Intuition: A pregnant person’s intuition is not to be discounted. If something feels off, listen to your gut, and get it checked out.

If left undiagnosed, a pregnant person will almost always show signs of ectopic pregnancy by about eight weeks.

How is it Diagnosed?

• Pregnancy Test: One may be administered, especially if you are exhibiting symptoms, without a prior confirmed pregnancy.
• Ultrasound: An ultrasound may show ectopic pregnancies occurring in the fallopian tubes, however, they may not show up at all. Pregnancy without a visible fetus is indicative of it being ectopic. A transvaginal (in the vagina) ultrasound may also be used. 
• Pelvic Exam: This will help show your provider any areas of pain, tenderness, or a mass outside of the uterus. 
• Beta hCG Blood Test: Your body produces the hormone human chorionic gonadotropin (hCG), during pregnancy. Low or slow rising levels may be used as a diagnostic test. 

These tests will typically be done in tandem with each other and may need to be repeated before giving a correct diagnosis. 

It’s not always clear right away whether or not a pregnancy is ectopic, and they can be difficult to diagnose. If something feels off, continue to advocate for further testing. 

What Are The Risk Factors?

While ectopic pregnancy can potentially happen to any pregnant person, there are certain risk factors that may increase someone’s chances. 

• Cigarettes: We all know the risks that come with lighting up, an ectopic pregnancy is one of them. 
• Pelvic Inflammatory Disease/Endometriosis: Although the risk is small, PID and Endometriosis have shown to increase the chance of tubal pregnancy.
• IUD: Pregnancy that occurs in someone who has an intrauterine device, may increase the chance of EP by 4-5 times. 
• Fertility Treatments: People who have undergone fertility treatments have a slightly increased risk of EP. 
• Prior Ectopic Pregnancy: There is about a 10% increased risk for subsequent tubal pregnancy after the first one. 

How Do You Treat It

Treatments for EP depend on when it is detected, and further complications, and of course the pregnant person’s preferences. 

• Expectant Management: About 40% of EP need no treatment, and end up resolving on their own – this is usually the case for those implanted in the fallopian tubes. Your provider may monitor your hCG levels, or some people choose to closely monitor their symptoms from the comfort of their home. 
• Methotrexate: Is the most commonly used pharmaceutical to treat EP. It helps to inhibit the growth of the fetus, preventing possible rupture. This injection can come with side effects like dizziness and headache, and requires blood test monitoring. You’ll also need prior blood tests to ensure your kidneys and liver are working normally before being given this medication. 
• Surgery: A surgical procedure called Laparoscopic Salpingostomy is done by cutting into the fallopian tube to remove the embryo. This is called a “key hole” surgery, as it’s minimally invasive. There is a risk of an ectopic reoccuring in the same place, so this procedure is only done if the other fallopian tube is abnormal. 
• Birth: In extremely rare cases, an ectopic pregnancy may be brought to full term with live birth, specifically in the case of abdominal pregnancy. These are few and far between, but it is possible!

Bodily Intuition 

Again, trust your intuition. Ectopic pregnancies can come with very serious risks, know the signs, and listen to your body. If you’re experiencing any symptoms of an ectopic pregnancy, it’s time to seek medical care.

Fact checked by:

Dr. Shree Datta

Dr. Shree Datta is a Consultant Obstetrician and Gynaecologist in London, specialising in women’s health including all menstrual problems such as fibroids and endometriosis. Dr. Shree is a keen advocate for patient choice, having written numerous articles and books to promote patient and clinician information. Her vision resonates with INTIMINA, with the common goals of demystifying periods and delivering the best possible care to her patients.

Article written by: