Ectopic Pregnancy 101

Everything you need to know about an ectopic pregnancy, an increasingly more common pregnancy complication.

One of every 50 pregnancies results in an ectopic pregnancy, which is where embryonic development occurs somewhere other than inside the uterus. What many people don’t realize is how potentially life threatening they can be. Recently, two friends of Every Mother Counts experienced ectopic pregnancies and we thought it was time to discuss this increasingly more common pregnancy complication.

What is an ectopic pregnancy?

When a fertilized egg can’t travel smoothly through the fallopian tube to the uterus where a normal pregnancy develops, it may try to implant somewhere else. In 98 percent of ectopic cases, the fertilized egg implants and grows inside the fallopian tube. The other 2 percent develop in other areas of the abdominal cavity or in the cervix.

How often do they happen?

They occur in about 2 percent of pregnancies, which is a significant increase from the 1970s when only 0.45 percent of pregnancies were ectopic. It’s thought that the increase has to do with improved diagnostic technologies, plus increased rates of sexually transmitted diseases and other conditions that cause pelvic inflammatory disease and scarring of the reproductive organs.

What are the symptoms?

The symptoms most commonly associated with ectopic pregnancy are abdominal pain, spotting, bleeding, nausea, weakness, dizziness and low blood pressure. If the tube has already ruptured, a mother may show symptoms of shock (pale skin, weakness, loss of consciousness, confusion, rapid pulse).

How is it diagnosed?

When a pregnant woman comes to her physician with abdominal pain, with or without bleeding, or if she has similar symptoms and is unaware that she’s pregnant, the first step is to confirm the pregnancy. This involves a blood test to evaluate her pregnancy hormone levels and an ultrasound to visualize the location of the developing fetus plus a pelvic exam. Once an ectopic pregnancy is diagnosed, treatment depends on how far along the pregnancy is and the severity or stability of mom’s condition.

What happens to the fetus?

The fetus rarely survives longer than a few weeks because tissues outside the uterus do not provide the necessary blood supply and structural support to promote placental growth and circulation to the developing fetus. If it’s not diagnosed in time, generally between 6 and 16 weeks, the fallopian tube will rupture. This is long before a fetus could survive outside of the mother’s body. The sad truth is that when a pregnancy is ectopic, the fetus will not survive.

How is it treated?

There is no medical technique for transferring an ectopic pregnancy to the uterus where it could develop into a healthy pregnancy and baby. The only treatment that ensures mom’s survival is termination of the pregnancy. This is called a therapeutic abortion because it is required to save mom’s health or life.

Occasionally, a mother’s ectopic pregnancy will resolve without treatment if the pregnancy spontaneously absorbs. The problem is we don’t have specific data that predicts which women will recover without treatment and which ones will suffer severe consequences. That’s why most cases of ectopic pregnancy are treated by aborting the pregnancy. That’s done in one of two ways:

  • By injecting the mother with a drug called methotraxate, or
  • By surgically by removing the tube and fetus

Methotrexate is commonly used for treating cancer because it destroys rapidly dividing cells. In pregnancy, the rapidly dividing cells are embryonic and placental, which shrink and are absorbed by the mother’s body. It’s estimated that 35 percent of patients can be treated successfully with methotrexate when the fetus is in an early stage of development, the tube has not ruptured and there’s no extensive abdominal damage.

Surgical removal of the tube and fetus may be done either through a small incision in the naval or a larger incision in the low abdomen that’s similar to one used for a C-section.

What happens to the mother?

Sometimes, ectopic pregnancies result in miscarriages, but more often, the fallopian tube where the fetus is implanted stretches and becomes inflamed and extremely painful. Most cases of ectopic pregnancy require emergency medical treatment because the growing fetus can cause the fallopian tube to rupture and as a result, massive internal bleeding can occur.

In developed, high-income countries where emergency health care is easily accessible, severe injury or death is rare. That’s because an ectopic pregnancy’s hallmark symptom — severe abdominal pain — drives women to get medical help immediately.

Prior to the age of modern medicine and even today in countries where safe diagnostic and surgical techniques are unavailable, ectopic pregnancy can result in maternal death in more than 50 percent of cases. In fact, it’s the leading cause of maternal mortality in the first trimester. When women can access the right healthcare, risk for death drops to less than five in 10,000 pregnancies.

Accurate statistics for maternal outcomes in developing countries are difficult to come by. Jessica Bowers, Every Mother Counts’ Portfolio Director has a masters in International Development from George Washington University and has travelled extensively in developing countries, working in areas where maternal health outcomes are dire. Bowers says, “Ectopic pregnancies usually occur so early in pregnancy and health centers may not have the technology or see the patient early enough to detect it, or may not have a record keeping system that records it.”

Can mom get pregnant again?

Many women can get pregnant again and go on to deliver healthy babies, but it depends on what caused her ectopic pregnancy in the first place, how much abdominal damage occurred, whether she still has a remaining fallopian tube and her willingness to risk having another complication. When a woman has had one ectopic pregnancy, she has a 15 percent chance of having another. If she’s had two ectopics, the recurrence rate is 30 percent.

What happened to our friends?

Jennifer Pastiloff, writer, yoga retreat leader and founder of the Manifest Station, experienced pain and bleeding shortly after discovering she was pregnant last year. She had known from the start that something was wrong and when her doctor diagnosed her pregnancy as ectopic, she was successfully, but painfully treated with methotrexate. Jennifer wrote an eloquent essay for The Rumpus about hopping on a plane to lead a yoga retreat shortly after receiving the injection. When the pain became too intense for her to continue teaching, she went to the emergency room for pain medication and reassurance that everything would be all right. The methotrexate worked, though not without a great deal of discomfort.

Christine Koenitzer is one of EMC’s running ambassadors and she’s experienced two ectopic pregnancies this year. Though her ectopic was treated surgically just two weeks ago (after methotrexate didn’t work), she’s recovered well enough that she’ll be participating in the JoyRide and Kilometers Ridgfield 5K race this weekend in Connecticut as a fundraiser for Every Mother Counts.

Topics: Maternal Health