A common complication early in pregnancy, an ectopic pregnancy can be life threatening if not detected. Also known as a tubal pregnancy, ectopic pregnancies occur in about seven of every 1,000 pregnancies in the United States alone.
While the incidents of tubal pregnancies are on the rise, maternal death rates associated with this type of pregnancy are decreasing steadily. Thanks to more sophisticated methods of detecting an ectopic pregnancy as well as increased awareness, the maternal death rate stands at less than one in 2,500 reported cases.
What is an Ectopic Pregnancy?
An ectopic pregnancy occurs when a fertilized egg implants itself outside of the uterus. The most common place for implantation to occur in an ectopic pregnancy is in the fallopian tubes, hence the moniker "tubal pregnancy". However, the fertilized egg may also implant in the ovary, cervix or abdomen. It is extremely rare for an ectopic pregnancy to result in a live birth.
Because the egg implants itself somewhere other than the uterus, it is not able to develop properly. As the egg grows, it stretches the organ in which it has implanted itself. Eventually, this organ, most likely the fallopian tube, will burst, increasing a woman’s risk of hemorrhaging, which requires immediate medical attention.
Signs of Ectopic Pregnancy
On the surface, symptoms of ectopic pregnancy mimic those of pregnancy, making it difficult to notice the warning signs. In general, though, typical ectopic pregnancy symptoms include:
- late period
- irregular vaginal bleeding
- lightheadedness, dizziness or fainting
- pain in the abdomen, shoulder, bladder and/or bowel
The most notable signs of ectopic pregnancy are sharp, stabbing pains, particularly in the abdomen. If you have had a positive pregnancy test and notice any of these tubal pregnancy symptoms, make an appointment with your health care provider right away.
Diagnosing a Tubal Pregnancy
Due to increased awareness about ectopic pregnancies, more prenatal health care practitioners are screening their female patients for this pregnancy complication. This increased vigilance is part of the reason why maternal death rates are declining despite the fact that ectopic pregnancy numbers are going up.
In order to diagnose an ectopic pregnancy, your health care provider will first administer a pregnancy test (if you do not already have a positive pregnancy test). Once a pregnancy is confirmed, a blood test will be performed to evaluate your levels of hCG.
In a healthy pregnancy, this hormone doubles roughly every two days until the 11th week pf pregnancy. However, in tubal pregnancies, hCG levels increase at a much slower rate.
In order to determine how your hCG levels are rising, your health care provider may monitor your levels over a period of days or she may calculate what they should be based on your last menstrual period and the approximate length of your pregnancy.
Blood tests done to measure the level of progesterone in your system may also be helpful as an ectopic pregnancy often produces lower than normal progesterone levels.
An ultrasound is commonly done in the early stages of pregnancy to see how the fetus is developing. During this routine procedure, your health care provider will be able to see not only your uterus, but also your fallopian tubes and ovaries. During this exam, it is possible for your health care provider to see whether the embryo has implanted in the correct location or not.
Treating an Ectopic Pregnancy
Because it is unlikely that the embryo will survive when it is implanted somewhere other than the uterus, and due to the risk of organ rupture and possibly maternal death, ectopic pregnancies are normally terminated.
So long as your fallopian tube has not ruptured, this can be accomplished through the use of methotrexate, an injection drug that dissolves the embryo, allowing the body to reabsorb it. This is often preferred as it is a noninvasive procedure and helps to reduce the amount of scarring to your reproductive organs.
If it is not possible to use methotrexate, the embryo may be flushed out through a salpinostomy or removed through laparoscopy. However, if the organ in which the embryo has implanted itself ruptures, an emergency laparoscopy must be performed to remove both the embryo and the organ, most likely the fallopian tube.
Once the embryo has been removed, you will receive follow-up care and monitoring. This is done to ensure that your hCG levels return to zero. If they do not go down, you may receive further treatment with methotrexate to dissolve any lingering embryonic tissue remaining in the tube.
Effects on Fertility
Experiencing a tubal pregnancy can affect your future ability to get pregnant. If scarring, trauma or damage has occurred to your reproductive organs, either because of the pregnancy or methods used to treat the ectopic pregnancy, it can make it more difficult to conceive in the future. Additionally, experiencing an ectopic pregnancy puts you at risk of suffering another one in the future.
However, just because you have had one ectopic pregnancy does not automatically mean you will be infertile. While losing a fallopian tube does reduce your chances of pregnancy to about 40%, pregnancy is still possible. Many women who have had a tubal pregnancy are able to successfully conceive again within a year of their ectopic pregnancy.
If you are concerned about your fertility, speak with your health care provider about what you can do to preserve your fertility as well as increase your chances of pregnancy after a tubal pregnancy.
Are You at Risk?
Certain factors can put a woman at increased risk of an ectopic pregnancy. In numerous incidents, a tubal pregnancy results due to a blockage or narrowing in the fallopian tube, preventing the fertilized egg from traveling to the uterus. Factors that can increase your risk of having an ectopic pregnancy include:
- Pelvic inflammatory disease
- Pregnancy over age 35
- Previous surgery on the fallopian tubes
- Previous ectopic pregnancy
- Use of certain ovulation medications
Moreover, if become pregnant while using an IUD, you have a significantly increased risk of developing an ectopic pregnancy.