Rebecca was a trained wilderness first responder. She knew about ectopic pregnancies. Still, when an embryo implanted in her Fallopian tube, Rebecca (who’s asked that we not use her last name) missed the signs of an ectopic pregnancy completely. “I didn’t even know I was pregnant,” Rebecca recalls. “I had suspicions, but a test came out negative, then I traveled to Hawaii for several weeks.” It was while she was in Hawaii that the bleeding started, along with painful cramps, two classic signs of ectopic pregnancy. But since her [linkbuilder id=”6463″ text=”pregnancy test”] was negative, Rebecca shook them off for days, then a week. Finally, nine days after it all started, she mentioned she’d been bleeding to a friend who happened to be a nurse. Suddenly, two and two came together to make four. “She sent me straight to the hospital, where I found out I was pregnant, miscarrying, and ectopic all at once,” Rebecca recalls. Rebecca’s life was saved by that trip to the hospital. An estimated 2 percent of pregnancies are ectopic pregnancies, and for women living in North America, this condition is the leading cause of death in the first trimester of pregnancy and accounts for anywhere from 10 to 15 percent of all maternity-related deaths. But what is an ectopic pregnancy? And are the signs really that easy to ignore? We talked to the experts about how ectopic pregnancy is defined, what they do to treat the condition, and how you can stay safe.
What is an ectopic pregnancy, anyway?
When someone gets pregnant, the embryo that’s created when sperm meets ovum is supposed to travel up the Fallopian tube and find its way to the uterus where it will hang out until birth, developing, growing, and turning into a human being. But when a pregnancy is ectopic, the embryo gets lost on its way to the uterus. Technically, an ectopic pregnancy is “any pregnancy that implants outside the uterine cavity,” says G. Thomas Ruiz, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California. In almost every case of an ectopic pregnancy—about 95 percent of the time—the embryo will implant itself in the Fallopian tube. In about 2.5 percent of ectopic pregnancies, the fertilized ovum can settle in at the cornua of the uterus (essentially the spot where the uterus and Fallopian tube meet). The other 2.5 percent are found in the ovary, cervix, or abdominal cavity.
What’s the problem here?
So the embryo didn’t go where it was supposed to. Why is that a problem? Well, every part of the female reproductive system has its own job. The uterus, of course, has the job of providing a growing fetus a safe place for development. The Fallopian tube, cornua of the uterus, ovary, cervix, and abdominal cavity, on the other hand, are not suited for a developing fetus. There simply isn’t room in those structures for what has to happen to get a baby from conception to birth. According to Cindy Basinski, an OB-GYN from Newburgh, Indiana, “Pregnancies that develop outside the uterus are dangerous because as the pregnancy grows it can rupture and cause life-threatening bleeding inside the abdomen.” Sometimes the body will figure out something is wrong, and essentially “fix” an ectopic pregnancy, stimulating a miscarriage early on. Sometimes a woman won’t even know she was pregnant, let alone that her body was dealing with an ectopic pregnancy. It’s when an ectopic pregnancy continues to grow, however, that the condition becomes something serious, Basinski says. Until the condition is treated—or if it ruptures—you might notice signs and symptoms like Rebecca’s.
Signs of an Ectopic Pregnancy
Notice Basinski said might. “Unfortunately, for some women, ectopic pregnancy may have very little to no symptoms until it ruptures, causing bleeding in the abdominal cavity—leading a woman to seek emergency care,” Basinski says. “It is unpredictable during growth of an ectopic pregnancy—[whether it’s] weeks or months—when this event may happen.” On the other hand, for many women, there are noticeable symptoms of experiencing ectopic pregnancy. Some women report bloating, nausea, or vomiting, although these symptoms are common in [linkbuilder id=”6462″ text=”early pregnancy”] and can easily be confused for garden-variety morning sickness. Pelvic pain that can’t be explained by period cramps or another source or vaginal bleeding in the early stages of a pregnancy, on the other hand, are reasons to call your OB-GYN immediately. Once you’re in their office, you may well be diagnosed with an ectopic pregnancy. “Pain may be related to stretching of the Fallopian tube as the ectopic grows within it or small amounts of bleeding leaking into the abdominal cavity from the growing pregnancy,” Basinski explains. “Vaginal bleeding may occur as pregnancy hormones are often not produced normally, causing bleeding.”
How is an ectopic pregnancy diagnosed?
Even after you tell your doctor that you’re feeling any of the signs of ectopic pregnancy, diagnosis can be tricky. In fact, according to a 2002 study published in the journal Obstetrics and Gynecology, almost 40 percent of ectopic pregnancy diagnoses are incorrect and are later revealed to be normal, intrauterine pregnancies. Avoiding this confusion comes down to talking to your doctor about what tests they’re performing. “If a person is truly diagnosed with an ectopic pregnancy by a physician, this is generally a very accurate diagnosis,” Basinski says. “Physicians are very careful to proceed to treatment of ectopic until they are certain because they do not want to harm a pregnancy if it is a normal one.” That’s why they require a number of tests before diagnosis or treatment. “If a physician is concerned that a patient may have an ectopic pregnancy, they will often follow a patient’s levels of beta-human chorionic gonadotropin (BHCG, a pregnancy hormone) to see if it is rising normally,” Basinski says. “If it is not rising normally, this can indicate either an impending miscarriage or ectopic pregnancy.” An ultrasound is the next step, allowing doctors to take a look inside to see if the embryo is located inside the uterus (where it belongs) or outside of the uterine cavity (making it ectopic). This is where things can get tricky. “It is difficult to see any pregnancy in any location until the pregnancy has grown enough to be seen—about four to five weeks,” Basinski notes. “If pregnancy levels reach a certain level but no pregnancy is seen in the uterus, this may be an indication of an ectopic pregnancy. If a pregnancy is seen outside the uterus, a definitive diagnosis of ectopic is made.”
Treating an Ectopic Pregnancy
After a definitive diagnosis of ectopic pregnancy, the first treatment most doctors reach for is methotrexate, Ruiz says. The medicine is used in other medical settings to treat everything from rheumatoid arthritis to certain cancers, and it’s contraindicated for most pregnant women because of potential harm to the fetus. However, in cases of an ectopic pregnancy, there is no saving the fetus, Ruiz says. “If the embryo is an ectopic, it will not survive,” he notes. “The risk to the mother can be loss of life, loss of the uterus, loss of the tube, or impairment to future fertility.” Prescribing methotrexate in cases of pregnancy (whether ectopic or intrauterine) stops the growth of the cells in the embryo, and the body will typically miscarry the pregnancy. “Methotrexate is used in early diagnosed ectopic pregnancies and basically prevents DNA replication in rapidly dividing tissue,” Ruiz explains. There’s a strict criterion before it’s prescribed, he adds, including a BHCG level that’s less than 5,000 milli-international units per milliliter and no fetal cardiac activity, to ensure the fetus is not viable. For some women, however, methotrexate doesn’t work. Rebecca’s ectopic pregnancy remained in her Fallopian tube even after she was treated with the drug, and her doctor had to go in surgically to remove the embryo and save her Fallopian tube, enabling her to get pregnant again in the future. Other women may have to have the affected tube removed completely, Ruiz says, if the methotrexate doesn’t work or if the diagnosis is not made soon enough. Typically this can be done laparoscopically, but if the tube has already ruptured, an ectopic pregnancy becomes a surgical emergency, requiring an abdominal incision. Although a D&C, short for dilation and curettage, may have once been a means to treat ectopic pregnancy, the procedure is rarely used today, Ruiz says. “Twenty-five years ago, if we were really stumped, we would do a D&C and send it for rapid frozen section,” Ruiz says. “If the rapid frozen section returned negative for chorionic villi we would proceed to laparotomy [a surgery where the surgeon cuts through the abdominal wall] for a presumed ectopic.” These days, Ruiz says, highly sensitive ultrasounds and blood testing have rendered the D&C essentially obsolete.
How does this all happen?
Ectopic pregnancies are not a woman’s fault. There’s nothing you do that makes the embryo implant in the wrong part of the body. But that doesn’t mean there aren’t risk factors at play, Basinski says. Those with a higher risk of ectopic pregnancy include women with a history of:
- Pelvic inflammatory disease due to a sexually transmitted disease
- Endometriosis causing damage to fallopian tubes
- Previous pelvic surgery for any reason, including appendectomy, tubal ligation, or tubal ligation reversal surgery.
A previous ectopic pregnancy can also increase your chances of having another one, as can smoking and the use of an IUD as a form of contraception.
Ectopic pregnancy prevention is possible (sort of).
There’s no way to tell whether or not a pregnancy will turn out to be ectopic. You can’t tell the embryo where to go, nor can you will it into the uterus. But if you aren’t specifically trying to have a baby anyway, condom usage can go a long way toward preventing ectopic pregnancy, Basinski says. After all, it’s one of the most effective means of preventing any pregnancy! If you do want to get pregnant and you have any of the aforementioned risk factors, hope is not lost. “Women with risk factors should let their physicians know so that together they can closely monitor future pregnancies to enable an early diagnosis and treatment,” Basinski says. In Rebecca’s case, ectopic pregnancy was not the end of her fertility journey. After two ectopic pregnancies, both of which ended in surgery, she tells HealthyWay, “I’m the mom of two beautiful boys, both conceived with IVF.”