What Is an Ectopic Pregnancy?

A fertilized egg is supposed to travel through the fallopian tube, into the uterus and implant in the uterine wall. It then begins developing into a fetus. Sometimes, a fertilized egg will attach outside of the uterus. This is called an ectopic pregnancy. Since a fetus cannot develop outside of the uterus, this type of pregnancy normally ends in miscarriage or medical termination.

What is a Tubal Pregnancy?

A tubal pregnancy is a non-viable pregnancy that happens when a fertilized egg attaches to the fallopian tube rather than the uterus. It is usually referred to as an ectopic or extrauterine pregnancy. However, ectopic pregnancies can also happen in other areas of the body, such as the abdominal cavity, the ovary, or the lower part of the uterus. 

In a tubal pregnancy, the fertilized egg is unable to reach the uterus and tries to grow by attaching itself to the fallopian tube instead. Unfortunately, the egg cannot survive outside of the uterus. If left untreated, tubal pregnancies are life-threatening and can cause internal bleeding or damage to nearby organs. 

Symptoms of a tubal pregnancy are similar to a normal pregnancy for the first few weeks, with symptoms of a missed period, nausea, or fatigue. However, as the fertilized egg continues to grow, symptoms worsen and become life-threatening. Some of the more noticeable symptoms include:

• Vaginal bleeding unrelated to menstrual bleeding
• Pelvic or abdominal pain, which can be severe
• Shoulder pain, specifically if blood is leaking from the fallopian tube
• A sensation or urge to have a bowel movement, specifically if blood is leaking from the fallopian tube
• Extreme lightheadedness or fainting

It is important that if you are in the earlier phases of pregnancy and notice the above symptoms, to call 911 or seek medical attention immediately. The longer the fertilized egg grows in the fallopian tube, the more likely it is to rupture and cause internal bleeding and damage to other nearby organs. 

Symptoms

The signs of an ectopic pregnancy often show up before you even know you’re pregnant, which can make it easy to pass them off as something else. If you experience any of these symptoms, you should call your doctor:

• Abnormal vaginal bleeding: Bleeding that occurs when it’s not the time of your normal menstrual period is a sign of ectopic pregnancy.
• Abdominal or shoulder pain: Sharp or stabbing pain in your pelvis can indicate an ectopic pregnancy. If the fallopian tube ruptures, blood can collect in your chest near the diaphragm and cause pain in your shoulder.
• Feeling faint or dizzy: This can be caused by blood loss from a ruptured tube and the resulting low blood pressure.

Ectopic pregnancy pain is typically experienced 6-8 weeks into the pregnancy. Prior to that time, symptoms may go unnoticed, or are experienced as normal pregnancy symptoms. Ectopic pregnancy pain is often felt on one side, in the abdomen, pelvis, or shoulder.

Causes

Several factors can increase your risk of an ectopic pregnancy. These risk factors include:

• Previous damage to your fallopian tubes: If you’ve had pelvic inflammatory disease or a sexually transmitted disease that caused scarring in your fallopian tubes, you may be more likely to have an ectopic pregnancy. Abnormalities in the fallopian tubes are also possible after pelvic surgery or in women who have endometriosis.
• Age: Women over 35 are more likely than younger women to have an ectopic pregnancy.
• Smoking: Cigarette smoking increases the risk of ectopic pregnancy.
• Fertility treatment: Fertility medications or other fertility treatments can increase the risk of ectopic pregnancy.

Diagnosis

If you are experiencing symptoms of ectopic pregnancy, your doctor can perform the following tests to diagnose the condition:

• Pregnancy test: A blood test can check for elevated levels of human chorionic gonadotropin (hCG), the hormone that increases during pregnancy.
• Blood pressure: Low blood pressure could indicate that you have internal bleeding.
• Pelvic exam: A physical exam can identify an area of tenderness in the fallopian tubes or locate a mass in the pelvic area.
• Ultrasound: Using ultrasound imaging can help the doctor see where the pregnancy is located.

Treatment

An ectopic pregnancy may resolve on its own and result in a miscarriage (often before you even know you are pregnant). If that does not happen, medical intervention may be necessary to prevent serious complications. These treatments may include:

• Medication: Drugs can be used to stop the pregnancy from developing and hopefully preserve the fallopian tube.
• Surgery: If a tube has not ruptured, your doctor may use laparoscopic surgery (a minimally invasive technique that requires only a small incision) to terminate the pregnancy. If the fallopian tube has ruptured, a larger incision will be made in your abdomen. Depending on the degree of damage, all or part of the fallopian tube may have to be removed.

Risks & Complications

There are several risks and complications of ectopic pregnancies. It is the leading cause of pregnancy-related deaths in the U.S within the first 3 months of pregnancy. When a fertilized egg or embryo implants into the fallopian tube, it has no ability to survive. There is not enough room for it to grow or enough blood flow to keep it alive. Once the egg dies, it may start leaking tissue and blood, which can cause complications. Additionally, sometimes the egg continues to grow in the fallopian tube, risking a rupture of the tube, which can cause internal bleeding, damage to nearby organs, or shock.

Can You Have a Baby After an Ectopic Pregnancy?

Your ability to get pregnant again after an ectopic pregnancy will depend on many factors, including your age and medical history. You will be at increased risk of developing another ectopic pregnancy, so be alert to the possible signs. If a fallopian tube was damaged or removed, you will have a harder time becoming pregnant naturally and may elect to use in vitro fertilization (IVF) or other fertility treatments.