Ectopic Pregnancy – All Your Questions Answered

by pregnancy journalist

When you get pregnant, the fertilized egg implants in the uterus, which is where your baby can develop and grow. But in an ectopic pregnancy, the egg implants outside of the uterus.

Like many pregnancy complications, ectopic pregnancies aren’t often discussed in conversation, so many women only really learn about them when they have one themselves. Around 1 in 50 pregnancies in the U.S. is an ectopic pregnancy — making it more common than you might think.

What is an ectopic pregnancy?

An ectopic pregnancy happens when a fertilized egg implants itself anywhere other than inside the uterus. Most ectopic pregnancies occur in the Fallopian tubes, which connect the ovaries and the uterus — which is why ectopic pregnancies are sometimes called ‘tubal pregnancies’.

Because the fallopian tubes can’t support a growing embryo, an ectopic pregnancy cannot lead to a healthy, growing baby. Ectopic pregnancies almost always end by around 16 weeks, but if you discover that you’re having an ectopic pregnancy before it ends naturally, you’ll be advised to accept immediate treatment to end the pregnancy.

What causes ectopic pregnancy?

Ectopic pregnancies can happen to anyone, and there isn’t always an obvious cause. However, there are a number of factors which may make ectopic pregnancy more likely.

These include:

  • Infection of inflammation of the Fallopian tube; this can cause a blockage which stops the egg from traveling all the way from the ovary to the uterus.
  • Scar tissue from an earlier infection or surgery
  • Growths in the Fallopian tubes, or abnormally shaped tubes

Women over the age of 35 are 4-8 times more likely to have an ectopic pregnancy than younger women, and health conditions which affect fertility, including endometriosis, also increase the risk.

How soon do you get ectopic pregnancy symptoms?

Signs that you might be having an ectopic pregnancy could include:

  • Late or missed period, and/or a positive pregnancy test
  • Sharp stabbing pain in the pelvis and/or abdomen
  • Pain in the shoulders
  • Dizziness, feeling weak or fainting
  • Bowel or bladder problems
  • Vaginal bleeding

The symptoms usually start at around the same time that normal pregnancy symptoms might start — around two weeks after your period should have started. At this point, it’s roughly 5 weeks since the egg was fertilized.

How is an ectopic pregnancy detected?

If an ectopic pregnancy is suspected, your doctor or midwife will usually offer a pelvic exam to help locate where the pregnancy has implanted. They’ll feel for a mass, and will ask you where (if anywhere) you feel pain or tenderness.

An ultrasound scan will be used to check whether this is an embryo developing in the uterus or not. And your levels of the pregnancy hormone hCG will be measured — the levels of this hormone are usually lower in an ectopic pregnancy than they would be if the embryo and placenta were developing healthily in the uterus.

In some cases, your physician may confirm an ectopic pregnancy with a procedure called culdocentesis, which involves inserting a needle into a small space at the top of the vagina. If blood is found in this space, it’s likely that the Fallopian tube has ruptured due to ectopic pregnancy.

How is an ectopic pregnancy treated?

The way an ectopic pregnancy is treated depends on a number of different factors, including where exactly the egg has implanted; how far the pregnancy has progressed; and whether the Fallopian tubes have stretched or ruptured.

Talk to your doctor to make sure you understand what the best route to take is, and don’t be afraid to ask questions if you’re unsure about anything. It’s normal to feel worried or scared, and your medical team should help you to feel as comfortable as possible.

Treatments could include:

  • Medication to help the body absorb the pregnancy tissues
  • Surgery to remove part or all of the Fallopian tube if it has ruptured and started to bleed, or to remove the pregnancy and repair the tube if it hasn’t yet been severely damaged

Following treatment, your hCG levels must be checked regularly until they’re back to zero to ensure that all of the ectopic pregnancy tissue was removed and your body is no longer producing pregnancy hormones.

How soon can I get pregnant after an ectopic pregnancy?

Your doctor will talk to you about future pregnancies — if they don’t, make sure you ask. How soon you can try to conceive again depends on the treatment you had for your ectopic pregnancy, and whether the Fallopian tube where the egg implanted was damaged or had to be removed.

Many women have healthy, normal pregnancies after an ectopic pregnancy. But in some cases, an ectopic pregnancy may make it less likely for a woman to have a successful pregnancy in the future. If this applies to you, your doctor will explain why and discuss all of your options with you.

I had an ectopic pregnancy and I feel really low — is this normal?

Yes — it’s totally normal. Even though having an ectopic pregnancy means that there was no chance your embryo could have developed into a healthy fetus, if you knew you were pregnant you’re highly likely to experience grief at the loss of the pregnancy. And even if you didn’t know you were pregnant until the ectopic pregnancy ruptured, it can still be shocking and upsetting.

Emotions after an ectopic pregnancy are made more complicated by your unsettled hormones, and by the potential affects that the pregnancy might have on your chances of having a healthy pregnancy in the future.

Be gentle with yourself, and accept that you’re going through a difficult time. It’s OK to feel sad, angry, confused or numb. If you think counseling would be helpful, your doctor should be able to refer you to someone who understands the issues you’re dealing with. And if possible, let close family and friends know what’s happened so that they can give you some extra support.

Sources:
1. https://www.verywellfamily.com/what-do-statistics-look-like-for-ectopic-pregnancy-2371730
2. http://americanpregnancy.org/pregnancy-complications/ectopic-pregnancy/
3. https://www.msdmanuals.com/en-gb/home/women-s-health-issues/complications-of-pregnancy/ectopic-pregnancy
4. https://www.ectopic.org.uk/patients/reasons-for-an-ectopic-pregnancy/
5. https://www.mountelizabeth.com.sg/healthplus/article/chances-and-health-risks-of-pregnancy-after-40
6. https://emedicine.medscape.com/article/83097-overview
7. https://kidshealth.org/en/parents/ectopic.html

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