Statistically speaking, about 1 in every 50 pregnancies in the United States is an ectopic pregnancy, that is about 20 out of 1,000 according to the American Academy of Family Physicians (AAFP) and between 6% to 16% of pregnant women who go to an emergency department in the first trimester for bleeding, pain or both have an ectopic pregnancy. Ectopic pregnancy is an important cause of maternal mortality in the United States but the most striking aspect of the ectopic pregnancy mortality rate is the variation by race with black females facing a higher risk of an ectopic pregnancy. 

Ectopic pregnancies are generally not safe for the mother and as such it is therefore very important to be able to identify the signs of ectopic pregnancy early especially for the mother’s immediate health and long-term fertility with the risk of further complications or reoccurrence greatly reduced when it is discovered and treated early. 

In the occurrence of an ectopic pregnancy, there can be different complications ranging from internal abdominal bleeding, blood loss, and bursting of the fallopian tube which is particularly very serious and can be life-threatening. 

What is an ectopic pregnancy?

An ectopic pregnancy, also called extrauterine pregnancy, occurs when a fertilized egg implants itself to the fallopian tube, abdominal cavity, or cervix instead of the uterus as it should in the normal pregnant process which affects the development of the egg. 

For a normal pregnancy process, fertilization takes place in the fallopian tube with the sperm cell and egg or ovum meeting together to fertilize. The fertilized egg then moves into the uterus developing into a fetus upon implantation along the womb lining and the egg remains in the uterus until childbirth. Unfortunately, ectopic pregnancies are not viable and cannot result in a baby.

While taking a pregnancy test would reveal if a woman is pregnant, physical examination can’t diagnose an ectopic pregnancy. Transvaginal ultrasound which involves the insertion of a wand-like instrument into the vaginal to determine if a gestational sac is in the uterus and a blood test which will be used to determine levels of hCG and progesterone are possible methods of diagnosing if a pregnancy is ectopic. 

It is not in every case that prediction and prevention will be possible in every case to prevent ectopic pregnancy but good reproductive health hygiene, quitting smoking, a regular visit to the gynecologist, and a limit on the number of sexual partners are a few ways to prevent the possibility of an ectopic pregnancy occurring.

What are the signs of an ectopic pregnancy?

It is necessary to mention that in most occurrences, ectopic pregnancy happens within the first few weeks of pregnancy and as such, it’s possible that someone may not realize that she is pregnant or has any complication regarding the pregnancy. Even after a positive pregnancy test, the pregnant woman may not realize it because an ectopic pregnancy appears similar to a normal pregnancy but there are still some early signs of an ectopic pregnancy that if detected should be reported to your doctor. Here are some of the signs:

• Sharp pain in the pelvis or one side of the abdomen
• Light vaginal bleeding or brown colored discharge
• Dizziness, weakness, or fainting
• Pain in the shoulder or neck
• Frequent nausea and vomiting
• Discomfort when peeing or pooping

These signs may not definitively mean that a case of an ectopic pregnancy, but emergency symptoms like major pain, severe bleeding, or belly pain can be signs of rupture to the fallopian tube and should immediately be reported to a doctor or emergency health service.

Causes of Ectopic pregnancy

The cause of an ectopic pregnancy is not always certain but in some cases, it is often caused by damage to the fallopian tube which blocks the passage of fertilized egg through it, and some other conditions which include:

Previous medical conditions

Conditions that may have affected the condition of the fallopian tube and other reproductive organs of the body such as infection, surgery, inflation, etc.

Genetic abnormalities

Some women may have pre-existing genetic abnormalities which could affect the pregnancy process leading to an ectopic pregnancy.

Hormonal factors

Hormones play an important role in our bodies and can cause medical issues when they’re not balanced. 

Endometriosis

Endometriosis is a disorder in which tissue that normally lines the uterus grows outside the uterus.

Smoking

Smoking can also be a likely cause of an ectopic pregnancy because it increases the odds of such complications and not just smoking by the woman but also the spouse.

Some medical treatments

Medical treatments such as in vitro fertilization which is a fertility treatment can be a likely cause of ectopic pregnancy in women who have gone through the treatment.

Ectopic pregnancy risk factors

In reality, every sexually active woman is at some risk of an ectopic pregnancy. Various factors increase the risk of an ectopic pregnancy occurring:

Maternal Age

Women aged 35 and above run the risk of an ectopic pregnancy. Simply put, the older a woman is when she gets pregnant from that age, the higher the risk of an occurrence. 

Previous ectopic pregnancy

The risk of an ectopic pregnancy reoccurring is almost 17 times higher for women who have had a prior case of an ectopic pregnancy. 

History of Sexually Transmitted Infections

Some sexually transmitted infections such as chlamydia and gonorrhea increase the risk of Pelvic Inflammatory Disease (PID) which can lead to an ectopic pregnancy.

Usage of Intrauterine device (IUD)

Conception taken in despite the use of this contraceptive method increases the risk of an ectopic pregnancy by 4-5-fold. IUD-induced inflammation, the pelvic pain after the insertion of the IUD increases the risk in IUD users.

Previous surgery

Undergoing surgeries including pelvic surgery, abdominal surgery, tubal surgery increases the risk of an ectopic pregnancy.

Before conception, if you have any of the risk factors listed above, it is advisable to speak to your doctor to understand the risks and minimize the risks for subsequent pregnancies. However, there is still the possibility that a woman has an ectopic pregnancy without any of these risk factors.

Ectopic pregnancy treatment

Knowing that the fertilized egg cannot develop properly into a child, it is dangerous for the mother and safe to remove the pregnancy before it grows too large. While the mother can decide to carefully manage and monitor the pregnancy in the hope that a natural miscarriage would happen, it is very dangerous and may lead to rupturing of the fallopian tube.

Depending on how early the pregnancy is determined and the location and development of the fetus, treatment may be recommended.

Medication

If detected early, the immediate complications are not as fatal as there would be little risk of rupture. Medication is recommended and methotrexate is the most common drug mostly used for the treatment. Methotrexate stops the rapidly growing cells and dissolves the existing cells. Usually, one shot of the drug is given and regular blood tests will be carried out to ascertain the effectiveness of the drug. A second dose of the drug may be needed in some cases.

Usage of this medication has some side effects which include:

• Dizziness
• Diarrhea
• Tummy pain or cramping
• Bleeding

It is important to take reliable contraception for a minimum of three months after taking this treatment because methotrexate can be harmful to a baby. It is also advisable to stay away from alcohol as drinking alcohol after receiving the medication can damage the liver.

Surgery

In the case where the pregnancy is far gone, surgery is recommended. Keyhole surgery which is also known as laparoscopy is performed to remove the ectopic tissue. 

For a laparoscopy, a small incision is made through which a small camera called a laparoscope is inserted to view the area. Surgeons may attempt to repair the fallopian tube if it is deemed to be damaged and remove the ectopic tissue. In a case where that cannot be done, a laparotomy which requires a larger incision to remove the damaged fallopian tube will be carried out. 

After the successful surgery, you must keep your incisions clean and dry to prevent infection while it heals up. Some signs which would help you know if your incision has been infected include excessive bleeding, swelling, redness, foul smell. It is equally important to drink plenty of fluids to replace lost fluids and avoid constipation, reduce carrying out strenuous activities especially activities that can strain the pelvis region including heaving lifting, sexual intercourse, exercise.

How will I feel after an ectopic pregnancy?

Whatever treatment process you undergo to remove an ectopic pregnancy, it is important to give your body enough time to undergo a recovery period, rest and heal. Depending on the treatment process undergone, you will feel a varying amount of pain which may continue for several days or weeks after the process. Aches, pains, soreness in the back, hip, neck, and leg are not uncommon in the days following surgery.

Abdominal adhesion which is a scar tissue that binds two parts of your tissue that should be separated together is also a common complication of surgery and it occurs in 93% of women who undergo pelvic surgery. In the few weeks after surgery, it is possible that you feel tired easily after carrying out light work or exercise and it is a sign that you need to give your body more rest.

Most importantly though is how you feel emotionally after an ectopic pregnancy. Everyone would not have the same reaction after an ectopic pregnancy and most women tend to feel emotionally weighed down and that is perfectly normal considering it involves the loss of a child but it is important to remember that the child may not likely have survived as she cannot grow adequately outside the uterus. Support from family, friends, and loved ones will help through the emotional process. Counseling may also be helpful as well as online forums as there is a risk of depression after an ectopic pregnancy.

Ectopic Pregnancy FAQs

What is the best timing for me to try again after an ectopic pregnancy?

While there is no clear researched answer, doctors advise you to wait for 3 months or at least two full menstrual cycles before trying to conceive to allow your menstrual cycle to return to its usual flow and for you to be able to determine your Last Menstrual Period (LMP) date.

What is assisted conception?

This involves the use of clomiphene which is an extremely powerful medication that is prescribed to help persons trying to get pregnant. It is used if the menstrual cycle is irregular which would not allow them to be sure of their ovulation period. Usually taken over 5 days, the drug blocks estrogen receptors in the brain, therefore, stimulating them to release naturally occurring stimulants during ovulation in a normal cycle.

Is there anything I can do to improve my chances of a normal pregnancy?

There are no specific concerns regarding ensuring you have a normal pregnancy next time but after an ectopic pregnancy, if you have persistent abdominal pain after an ectopic pregnancy, see your doctor just to be sure there is no infection that might increase your chances of ectopic pregnancy in future. 

Do supplements and alternative therapies work?

There is no medically approved assurance that the use of supplements from the internet or varying therapies will reduce the chances of an ectopic pregnancy.

Conclusion

Having an ectopic pregnancy does not necessarily mean that you may not have a healthy pregnancy again as most people who have had such pregnancy do go on to have healthy pregnancies after depending on the physical damage caused. If even just one of the fallopian tubes is still intact, an egg can still be fertilized normally. This is why it is important to detect suspicious signs of an ectopic pregnancy early as early detection can be treated with medication instead of surgery. 

It is also important that you speak with your doctor before trying again or a fertility specialist especially if a fallopian tube has been removed and in the case that you get pregnant, early and regular testing in the first few weeks of your pregnancy can let you know if the pregnancy is normal or not.