According to the March of Dimes, about 1 in every 50 pregnancies in the United States is ectopic — the world literally means “occurring in an abnormal position.” While that’s not incredibly common, chances are you know someone who has experienced this unusual pregnancy complication.
So what exactly is an ectopic pregnancy? An ectopic pregnancy is when a fertilized egg implants outside the uterus. It’s usually in a Fallopian tube (hence the common term “tubal pregnancy”), but can be elsewhere too, like on the ovary or the cervix. Over 90% of ectopic pregnancies are located in a Fallopian tube. No matter where the embryo implants, it’s not a viable pregnancy, as a fetus cannot develop outside of the uterus. These types of pregnancies are extremely dangerous, with a risk of blood loss or rupture of the tube. Ruptured ectopic pregnancies are the leading cause of maternal death in the first trimester.
There are certain risk factors that can make the chances of having an ectopic pregnancy go up, like being over age 35, being a smoker, using an IUD, previous abdominal surgery, or previous pelvic inflammatory disease or inflammation of the reproductive organs. Most ectopic pregnancies happen in people who have been pregnant before, although they can occur in any sexually-active person of reproductive age. Signs of ectopic pregnancy usually occur within 6-8 weeks of your last period and can include bleeding, abdominal tenderness, nausea, dizziness, or symptoms similar to those of appendicitis or a UTI. Of course, some of these symptoms (like that dreaded nausea) are also associated with normal first trimester pregnancies, but if you feel anything is off, it’s completely fine to call a medical professional to be seen.
Dr. Georgia Ragonetti-Zebell, an OBGYN in South Carolina who blogs at MommaDocs, experienced her own ectopic pregnancy when she was in her late twenties. Her pregnancy was attached to her ovary, and she experienced sharp pain and dizziness. She explains, “Some women have no symptoms. An ectopic pregnancy may be suspected by abnormally rising pregnancy hormone levels and an abnormal or inconclusive ultrasound. If the ectopic is bleeding, you may also feel lightheaded or dizzy, and have upper abdominal or shoulder pain. You may have to get several ultrasounds or blood work every few days before your doctor knows what exactly is going on. It can be frustrating, not knowing if the pregnancy is normal. It is an unfortunate limitation of modern medicine, and we find it frustrating too.”
As soon as ectopic pregnancies are discovered (usually with a transvaginal ultrasound) they need to be treated. Depending on where the pregnancy is and how far developed it might be, there are two main options for treatment: a medication called methotrexate or surgery. Of methotrexate, Dr. Ragonetti-Zebell explains, “The medicine basically halts cell reproduction (it’s used to treat cancers), and so prevents the pregnancy from growing. The body will then absorb the pregnancy tissue, and you can avoid surgery. It does require close follow up, has some unpleasant side effects like vomiting and dizziness, and there is always the risk that the tube can rupture, so it’s not for everybody.”
“If there is any internal bleeding and the woman is unstable, surgery is required, “ she says. For surgical options, laparoscopic surgery (a minimally invasive surgery that uses a small incision in the abdomen) is often used. Dr. Ragonetti-Zebell advises, “If the tube is not ruptured, sometimes it is possible to open the tube and remove the pregnancy. The tube can be then be saved, but the pregnancy hormone level must be followed down to zero. If the tube is ruptured, it usually must be removed.” In her own case, her ovary and tube was saved, and she was back to work the next week.
Patricia Aswan, a freelance writer, had an ectopic pregnancy before she had her two children. In her case, one of her Fallopian tubes was removed because of rupture and she required several blood transfusions. Still, most people (about 60%) who have ectopic pregnancies go on to have normal pregnancies in the future, if they want them. Some will need fertility treatment (especially if a Fallopian tube has been removed) but others will get pregnant with no issue. Dr. Ragonetti-Zebell and Aswan each went on to have two healthy pregnancies after their ectopics.
Having an ectopic pregnancy does increase your chances of having another one in the future, making you about 12% more likely. Some doctors will want to monitor you from the beginning the next time you get a positive pregnancy test. Make a plan with your doctor for follow-up after treatment, especially if you want to try to get pregnant again.
If you or someone you know is undergoing or has experienced an ectopic pregnancy, be kind, gentle, and supportive. Acknowledge the pregnancy as a true loss, if it was a wanted fetus. Aswan advises: “It’s okay to grieve the lost baby.” Dr. Ragonetti-Zebell, too, emphasizes making space for the grieving process: “Ectopic pregnancies can be quite emotional. There is the loss of a pregnancy, just like miscarriage. Allow time to grieve and heal.”