If you watched Grey’s Anatomy’s first seasons, you may vaguely remember something about Christina Yang getting pregnant and then passing out in the operating room, subsequently requiring emergency surgery. When I first saw it, I remember thinking, “What is that about??” The answer? She suffered an ectopic pregnancy that ruptured. As with most incidents on Grey’s Anatomy, the way hers played out was the most emergent, but it does show the importance and seriousness of ectopic pregnancy.
What Is Ectopic Pregnancy?
All pregnancies begin with an egg being fertilized when the sperm meets the egg. Fertilization results in a new cell with genes from both parents that is called a zygote. In the days following fertilization, the zygote continuously divides into a hollow ball of cells called a blastocyst, which will continue to divide off and form different systems of the body as they grow. The blastocyst moves down the fallopian tube and into the uterus to implant into the uterine lining, where it will continue to grow. At about 9-10 days old, the blastocyst is implanted in the uterus and is now an embryo.
Simply put, an ectopic pregnancy (also called a tubal pregnancy) happens when the egg doesn’t leave the fallopian tubes and instead implants inside the tube (95% of the time). Rarely, the fertilized egg can implant in other areas of the body, such as the ovary, abdominal cavity, or cervix. This can also be called an extrauterine pregnancy.
To see a video explanation from a Stanford doctor, click here.
Why is this Bad?
The fallopian tube is not a flexible organ like the uterus and is not equipped to support a growing pregnancy. As the embryo grows it can cause rupture of the fallopian tube, leading to heavy bleeding that is life-threatening if left untreated. It is important to contact your doctor immediately if you experience any symptoms (mentioned below) so that if necessary, you can be treated quickly.
Can An Ectopic Pregnancy Survive?
No. Because the fallopian tube cannot grow and stretch with the embryo, the embryo will not be able to develop. In the vast majority of cases, by the time the ectopic pregnancy is discovered, the embryo will have already passed away. Historically, this pregnancy complication was often fatal, but with medical advances today, women are able to be treated and retain their fertility.
How Common is Ectopic Pregnancy?
Ectopic pregnancy occurs in about 1-2% of all pregnancies (or one in fifty), and symptoms typically start to appear between 4-12 weeks of pregnancy.
Risk Factors
You are more likely to experience an extrauterine pregnancy if you have one or more of the following:
- a previous ectopic pregnancy
- pelvic inflammatory disease
- untreated chlamydia and/or gonorrhea
- endometriosis
- are a smoker
- are older than 35
- have used IVF to become pregnant (ACOG)
- got pregnant with an IUD in place (Mayo Clinic)
what are the Symptoms of ectopic pregnancy?
Initially, the symptoms of a tubal pregnancy and normal pregnancy may be similar to a normal pregnancy, such as a missed period or nausea. However, if you have had a positive pregnancy test or your period is late, talk to your doctor immediately if you experience one or more of the following:
- One-sided abdominal pain that can radiate to your shoulder or neck area
- Dizziness or fainting
- Heavy vaginal bleeding
How is an Ectopic pregnancy Diagnosed?
Having an ultrasound following a positive pregnancy test is the most helpful tool to diagnose an ectopic pregnancy. Through ultrasound, your provider can verify that the embryo is implanted into the uterus or if it looks like it could be outside of the uterus. If it appears that your pregnancy is ectopic, immediate care is advised.
How is an Ectopic Pregnancy Treated?
An ectopic pregnancy needs to be treated immediately to avoid fallopian tube rupture, and the type of treatment will depend on whether or not the fallopian tube is still intact and the level of bleeding you are experiencing.
Medication
If an ectopic pregnancy is caught early, it can usually be treated with an injected medication called methotrexate, which will stop the growth of the embryo and dissolve existing cells. Your doctor would order follow-up labs to determine if this treatment has worked. On rare occasions, an additional dose of methotrexate is necessary.
Surgery
If surgery is required, the type of surgery used to treat ectopic pregnancy depends on the severity of bleeding and whether or not the fallopian tube has ruptured. Both surgeries are performed via a small incision in your lower abdomen.
- Salpingectomy means that both the pregnancy and fallopian tube are removed.
- Salpingostomy means that just the pregnancy is removed and the fallopian tube is left to heal.
Frequently Asked Questions
I’m planning to get an abortion. DoES THIS information STILL APPLY TO ME?
Yes. Even if you are planning to get an abortion, the safest thing to do is to make sure that your pregnancy is located in the uterus. Abortion medications target the uterus (and embryo inside), so an extrauterine pregnancy would not be affected by the medication. Even with a surgical abortion, you should have an ultrasound ahead of time to make sure the pregnancy is in the correct location.
Because the symptoms of ectopic pregnancy and a medication abortion are similar, it can be hard to differentiate the two. Leaving an ectopic pregnancy untreated could lead to rupture and further complications. During a pre-abortion screening at Alpha Center, an ectopic pregnancy will be ruled out or, if our nurses are concerned that you may be experiencing one, you will be sent on for further evaluation by an OBGYN.
Is treatment for TUBAL PREGNANCY illegal?
No. Because these pregnancies aren’t viable (and in many cases, there is no heartbeat to begin with), there are no laws prohibiting treatment. Even in states with abortion bans, all of the laws include either 1) an exception for the treatment of ectopic pregnancy or miscarriage management, or 2) exceptions to preserve the life of the mother.
Last Updated September 17, 2024. Authored by Kristen Long for Alpha Center and reviewed by our Nurse Manager.
References
ACOG. (n.d.). Ectopic Pregnancy. ACOG. Retrieved September 10, 2024, from https://www.acog.org/womens-health/faqs/ectopic-pregnancy
Cleveland Clinic. (2022, April 29). Blastocyst: Definition, Stage & Implantation. Cleveland Clinic. Retrieved September 10, 2024, from https://my.clevelandclinic.org/health/body/22889-blastocyst
Dube, N. (2022, October 31). Ectopic Pregnancies and State Abortion Laws. Connecticut General Assembly. Retrieved September 10, 2024, from https://www.cga.ct.gov/2022/rpt/pdf/2022-R-0250.pdf
Federal Drug Administration. (2023, 09 1). Questions and Answers on Mifepristone for Medical Termination of Pregnancy Through Ten Weeks Gestation. U.S. Food and Drug Administration. Retrieved 09 10, 2024, from https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifepristone-medical-termination-pregnancy-through-ten-weeks-gestation
Mayo Clinic. (n.d.). Ectopic pregnancy – Symptoms & causes. Mayo Clinic. Retrieved September 10, 2024, from https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088
National Library of Medicine. (2023). Ectopic Pregnancy – StatPearls. NCBI. Retrieved September 10, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK539860/
Mignini L. Interventions for tubal ectopic pregnancy; RHL commentary (last revised: 26 September 2007). The WHO Reproductive Health Library; Geneva: World Health Organization