You might have heard about ectopic pregnancies and you’re not 100% sure what they are. Or perhaps you have some questions about risk factors and how or why ectopic pregnancy occurs.
Read on, as we explain what there is to know about ectopic pregnancy: diagnosis; risk factors; how to treat ectopic pregnancy; and much more.
What is an ectopic pregnancy?
An ectopic pregnancy is a pregnancy that implants outside of the endometrium (the inner lining of the uterus).
For pregnancy to occur, an ovary releases an egg during ovulation. This egg is received by one of the fallopian tubes.
If sperm arrives while the egg is in the fallopian tube then the egg is fertilized. The fertilized egg usually carries on its journey towards the inner part of the womb, the endometrium.
In every menstrual cycle, the endometrium grows and develops to nurture the fertilized egg. If pregnancy doesn’t occur, then the nurturing lining is shredded during menstruation.
In the vast majority of cases when pregnancy occurs, the fertilized egg implants itself in this nurturing layer, which nourishes the fertilized egg until the placenta develops and takes over this role.
In an ectopic pregnancy, for the first few weeks the fertilized egg grows normally but doesn’t make it to the uterine cavity. On its way to the endometrium it finds an obstacle, which ends its journey. The fertilized egg doesn’t attach anywhere but keeps growing.
An ectopic pregnancy usually occurs in a fallopian tube; this is also called a tubal pregnancy. If ectopic pregnancies occur outside of the fallopian tubes they’re called non-tubal ectopic pregnancies.
What causes ectopic pregnancy?
The main causes of an ectopic pregnancy are those that cause inflammation of the reproductive system.
The presence of scar tissue also plays an important role in the development of an ectopic pregnancy.
If the fallopian tubes are inflamed or there’s scar tissue present, their diameter is significantly reduced, which means the embryo cannot make it to the endometrium.
Ectopic pregnancy risk factors
Anything that causes inflamation or tissue scarring will increase the risk of an ectopic pregnancy.
Here are some of the risk factors:
#1: Pelvic inflammatory disease
Research shows that various conditions can cause pelvshows flammatory disease. The two most frequent causes of pelvic inflammatory disease are chlamydia and gonorrhea.
They are both sexually transmitted infections that cane be easily prevented and treated. Chlamydia might be asymptomatic for a long time, so sexually active women are encouraged to practise safe sex and have regular checks for sexually transmitted infections.
#2: Previous ectopic pregnancy
If you’ve had a previous ectopic pregnancy, you’re at a higher risk of it occurring again. This doesn’t necessarily mean a future ectopic pregnancy will happen. Your healthcare provider will keep a closer eye on the development of your new pregnancy, to make sure the fertilized egg implants in the right place.
If you develop an ectopic pregnancy, you will be taken care of before there is a ruptured ectopic pregnancy, where the fallopian tube ruptures due to the growing embryo. It is considered a medical emergency and women who have a ruptured ectopic pregnancy might need life saving emergency surgery.
#3: Scar tissue
The presence of scar tissue that gets in the way of the fertilized egg will increase your chances of developing an ectopic pregnancy. Scar tissue from previous abdominal surgery can be present in the fallopian tubes. Any surgery in the abdominal cavity, such as a cesarean section, previous tubal surgery or an appendectomy, can increase your chances of developing an ectopic pregnancy.
#4: Birth control
Research shows that an intrauterine device (IUD) will increase the chances of developing one or more of the above risk factors; therefore, it will increase the chances of an ectopic pregnancy.
Endometriosis is a condition where the endometrium grows outside of the uterine cavity. This causes inflammation and, on occasions, scar tissue.
Read more about this in Study: Endometriosis Increases Risk Of Miscarriage, Ectopic Pregnancy.
#6: In vitro fertilization
According to this study, not only might infertility be caused by presence of inflammation or scar tissue but embryo transfer of cryopreserved thawed embryos might also play a role in the development of ectopic pregnancies.
Will ectopic pregnancy show positive in a urine test?
When the egg is fertilized by the sperm, pregnancy occurs and the hormone human chorionic gonadotropin (hCG) is secreted. This is known as the pregnancy hormone as it’s responsible for keeping the pregnancy going until the placenta develops (about week 10-12). Most home pregnancy tests look for levels of hCG.
When a pregnancy occurs, the production of hCG increases and the pregnancy test will show positive, regardless of where the embryo has implanted.
Read more about hCG in BellyBelly’s article hCG Levels – What Should They Be Each Week?
Does ectopic pregnancy show in a blood test?
A blood test is more acurate than a urine pregnancy test. A blood test will confirm the pregnancy, even when the urine pregnancy test cannot. However, a blood test will just confirm pregnancy.
It cannot confirm where implantation has occurred, so ectopic pregnancies don’t show up on blood tests as ectopic. A blood test will simply confirm the pregnancy.
How long can an ectopic pregnancy survive?
An ectopic pregnancy lasts several weeks. The embryo has its own nourishment, which lasts a long time.
In a normal pregnancy, the placenta is fully developed by week 12 and takes over the role of providing nutrients.
The maximum time an ectopic pregnancy can last is around 16 weeks. A baby needs to be at least 24 weeks to have a chance at survival outside the uterus.
Unfortunately an ectopic pregnancy is not a viable pregnancy.
How soon would you know if you have an ectopic pregnancy?
How is an ectopic pregnancy diagnosed? This will depend on the individual case.
Some women will experience dull, one-sided abdominal pain; others might experience non-localized general pelvic pain. Some might experience sharp, severe pain or even shoulder pain. Others don’t have any symptoms of an ectopic pregnancy until an ultrasound scan is performed and the ectopic pregnancy is diagnosed.
An ectopic pregnancy is a non viable pregnancy. Just note any unusual pain or any vaginal bleeding you might experience and trust your intuition.
Intuition is a way of comunicating with our inner self and we should listen to it.
Chances of ectopic pregnancy
The chances of having an ectopic pregnancy are not very high. Research has been quite consistent in the past few decades and, in the developed world, 1-2% of all reported pregnancies are ectopic pregnancies. It is believed that the incidence is higher in developing countries, although the numbers are unknown.
Ectopic pregnancy symptoms
Symptoms of an ectopic pregnancy start as normal early pregnancy symptoms.
You can read more about this in Pregnancy Symptoms | 17 Early Signs You Might Be Pregnant.
More serious, specific symptoms of ectopic pregnancy are:
- Dull one-sided abdominal pain
- Vaginal bleeding. Vaginal bleeding in an ectopic pregnancy can be life threatening, even if the amount of blood loss doesn’t seem too worrying. Light vaginal bleeding accompanied by abdominal pain could be a sign of severe internal bleeding, even life threatening bleeding. Contact your health care provider if you experience any bleeding during the first weeks of pregnancy even if it’s not severe bleeding
- Shoulder pain. When internal bleeding occurs in the abdomen, the tip of the shoulder blade and even the neck can become very painful. This is because the blood pools underneath the diaphragm, irritating the nerves in the area
- Discomfort when going to the toilet. You might experience discomfort when weeing or pooing, as the area is inflamed.
When does ectopic pregnancy pain start?
It really depends on each pregnancy.
The pain can start as early as 5 weeks from your last period up to the second trimester.
After your missed period and once you know you’re pregnant, be aware of any of the symptoms of an ectopic pregnancy mentioned above. Contact your healthcare provider if you experience one-sided pain, whether accompanied by bleeding or not.
Always follow your intuition. If you feel something isn’t quite right, get in touch with someone who might be able to help.
Ectopic pregnancy treatment
How is an ectopic pregnancy treated? This is a common question.
Once an ectopic pregnancy has been diagnosed and depending where the ectopic pregnancy is trying to implant itself, a decision will be made about the best way to proceed with the pregnancy.
The preferred option is expectant management, where you are closely monitored while waiting to see whether medical treatment or surgery is needed.
Methotrexate treatment for ectopic pregnancy
If the pregnancy keeps growing, the team that is caring for you will quite likely suggest methotrexate treatment.
A single dose methotrexate therapy is administered by injection and it will stop the pregnancy from growing. Once this option has been selected, you will be monitored to check on your wellbeing. Your levels of hCG will also be checked, to make sure they go back to normal and the pregnancy is reabsorbed.
Surgical removal of ectopic pregnancy
Sometimes, the pregnancy will endanger the woman’s life, especially if it has grown a lot and the ectopic pregnancy is in a fallopian tube.
In severe cases surgery may be necessary.
A surgical approach will be necessary when the fallopian tube has ruptured or the fallopian tube is at risk of rupturing. With surgery, the ectopic pregnancy will be removed; in many cases the affected fallopian tube will also be removed.
A ruptured ectopic pregnancy is the leading cause of maternal death in the western world.
Can a baby survive from ectopic pregnancy?
The baby’s placenta starts developing around the time you miss your period. The fertilized egg has been dividing again and again into a bunch of identical cells while it travels towards the uterine cavity.
A few of these cells attach themselves to the uterine wall and, being identical to those that are going to make your baby’s organs, functions and other beautiful bits, they will become specialised cells for making the placenta.
The placenta will be fully functioning by week 10-12.
Until then, the embryo has a enough nourishment to last until your glowing endometrium takes over, ideally a few days later.
Everything is beautifully and precisely designed – from that fantastic sexual encounter to holding your baby in your arms.
If the fertilized egg doesn’t make it to the inner lining of the endometrium, the cells inside keep working, unaware of what’s happening. No matter what, they’re highly specialized for becoming a perfect baby. They will do their total best to keep going.
The few cells that were going to implant themselves in the uterine wall, however, don’t specialize to create the placenta because that only happens when the right number of cells attaches to the inside of the uterus.
Unfortunately, an ectopic pregnancy cannot be saved.
Read more about this in Ectopic Pregnancy | Symptoms, Signs And Treatment.