What Is an Ectopic Pregnancy?

Ectopic pregnancies occur when a fertilized egg (embryo) implants outside the uterus (womb).  

An ectopic pregnancy is not viable, meaning the pregnancy can't continue. A fertilized egg can't survive outside the uterus, and healthcare providers can't move it to the uterus.

According to the American College of Obstetricians and Gynecologists (ACOG), over 90% of ectopic pregnancies occur in a fallopian tube (the tube connecting the ovaries to the uterus). You may hear healthcare providers call this a “tubal pregnancy.” 

While it’s rare, ectopic pregnancy can also occur in other areas outside of the uterus, such as:

• The ovaries (reproductive organs on each side of the uterus)
• Cervix (opening the uterus)
• Abdominal (belly) cavity

As the fertilized egg grows, it can cause a rupture of the fallopian tube. A rupture can result in internal bleeding, becoming a life-threatening emergency. It requires immediate surgery for the safety of the mother.

Treatment options involve medication or surgery to terminate the pregnancy and remove the ectopic tissue. This depends on the length of the pregnancy and if there was a rupture.

Causes of Ectopic Pregnancy

Sometimes the cause of an ectopic pregnancy is unknown. Half of the people with an ectopic pregnancy did not have risk factors.

But, typically, ectopic pregnancies occur due to structural damage, scarring, or blockage of the fallopian tubes. 

The following are examples of conditions that could cause damage or blockage.

• Pelvic inflammatory disease (PID) (infection in the female reproductive organs)
• Sexually transmitted infections (STIs)
• Endometriosis (health condition where tissue similar to the uterine lining grows outside the uterus)
• Prior surgeries that caused scarring within the pelvis (between the hips)
• Scarring after a ruptured appendix (a small pouch attached to the large intestine)
• Congenital abnormalities of the fallopian tubes (birth defect that affects the structure of the fallopian tube)
• Previous fallopian tube surgery, such as tubal ligation (getting tubes tied to prevent pregnancy) or tubal reversal

Risk factors for ectopic pregnancy include:

• Previous ectopic pregnancy (risk increases by 10 times compared to those who have not had an ectopic pregnancy)
• Age (over 35)
• Getting pregnant while you have an intrauterine device (IUD)
• History of infertility and the use of assisted reproductive technology (ART)
• Smoking at the time of conception (smoking can damage the fallopian tubes)
• Multiple sexual partners (increases the risk of STIs and PID)

Symptoms of Ectopic Pregnancy

Ectopic pregnancy symptoms can begin the 4th week after conception (or at any time after that, throughout the first 12-16 weeks). However, the symptoms and pain most commonly begin between the sixth through the ninth week after conception. 

The early signs of an ectopic pregnancy may mimic typical pregnancy and include:

• Missed menstrual period
• Tender breasts
• Nausea

In addition, common signs and symptoms of an ectopic pregnancy include: 

• Abnormal vaginal bleeding (may be light or heavy)
• Abdominal (belly) or pelvic (between the hips) pain or cramping, usually on one side

If the area around the ectopic pregnancy (typically a fallopian tube) ruptures and bleeds, symptoms also include:

• Sudden, severe, sharp pain in the lower abdomen
• Shoulder pain
• Dizziness or fainting
• Intense rectal pressure
• Low blood pressure

Seek immediate medical emergency treatment if you have signs and symptoms of a ruptured ectopic pregnancy. This can cause internal bleeding and can be life-threatening.

Ectopic Pregnancy Treatment

An ectopic pregnancy is not viable, meaning it always results in pregnancy loss. Healthcare providers can't move the pregnancy to the uterus.

Healthcare providers will use imaging tests, blood work, and physical examination to determine the location of the ectopic pregnancy and if it is causing complications.

Treatment options involve medication or surgery to terminate the pregnancy and remove the ectopic tissue. It depends on how far along the pregnancy is and if there is a rupture.

Healthcare providers prefer to treat ectopic pregnancies with medication rather than surgery. However, surgery may be necessary for the mother's safety, especially after a rupture.

Medication

The most common medication treatment for ectopic pregnancy is Otrexup, Rasuvo, RediTrex (methotrexate). Methotrexate is given as a one or two-time injection (shot). However, it is not an option if there is already a rupture of the fallopian tube.

This medication stops the cells from growing and typically dissolves the pregnancy tissue within two to four weeks. However, it can take up to eight weeks.

Healthcare providers will schedule follow-up appointments and blood tests to check human chorionic gonadotropic (hCG) levels within the first week after methotrexate. 

Surgery

Emergency surgery is necessary if the ectopic pregnancy causes a rupture or the need for a fallopian tube and pregnancy tissue removal.

Surgery involves removing the ectopic pregnancy tissue and some or all of the fallopian tube (if that is the location of the fertilized egg).

Surgeons typically perform a laparoscopy under general anesthesia (medication to put you to sleep) to remove an ectopic pregnancy. This minimally invasive technique allows the surgeon to use small, keyhole incisions rather than a large, open incision.

In cases where there is significant hemorrhage (bleeding) or shock, additional treatments may include: 

• Blood transfusion (giving donor blood to replenish blood loss)
• Intravenous (IV, in the vein) fluids
• Oxygen (to oxygenate cells and tissues that normally get oxygen from the blood)
• Keeping the patient warm

Ectopic Pregnancy Prognosis

Ectopic pregnancy always ends in the loss of the pregnancy. The prognosis for the mother depends on early recognition and treatment. When there is an early diagnosis, treatment is very effective.

Possible Complications

While most mothers recover well after treatment, complications can occur and be life-threatening. The chance for complications increases as the pregnancy progresses, with rupture, and with more invasive treatments (surgery).

Possible complications from ectopic pregnancy include: 

• Hemorrhage (internal bleeding)
• Shock (body shuts down from loss of blood)
• Damage to the fallopian tubes (which can affect the ability to have successful pregnancies in the future) 

Future Pregnancies

About 10-20% of people with one ectopic pregnancy have a recurrence (another ectopic pregnancy). However, one out of three women has a successful intrauterine (in the uterus) pregnancy after an ectopic pregnancy.

Conception can occur the following month after treatment. However, it’s best to wait a few months before trying to conceive to let your fallopian tubes heal. It's important to talk to your healthcare provider to discuss when it's safe for you to get pregnant again. If you received methotrexate or had surgery, you may need more time to heal before trying to conceive.

Successful future pregnancies depend on:

• Age (higher risk of ectopic pregnancy after 35)
• Previous pregnancies and births
• The reason for the previous ectopic pregnancy
• Treatment for the first ectopic pregnancy (early treatment and no complications increases a person's chance of achieving future successful pregnancies)
• Overall health 
• The health of the fallopian tubes 

It’s important to note that miscarriages have an impact on the mental health of the mother. If are experiencing the negative mental health impact of a miscarriage, reach out to loved ones, support groups, a mental health professional, or your OB-GYN provider.

A Quick Review

Ectopic pregnancy is a rare but serious condition where fetal tissue implants outside the uterus (womb), typically in a fallopian tube. It always results in pregnancy loss. 

Symptoms of an ectopic pregnancy include abnormal vaginal bleeding and abdominal (belly) or pelvic (between the hips) pain on one side. 

If the fallopian tube ruptures, it can cause sudden, severe, sharp pain in the abdomen, shoulder pain, and dizziness. A rupture is a medical emergency. 

Treatment includes medication or surgery. This depends on how far along the pregnancy is and if there is a rupture. Medication is not an option with a rupture.

Early recognition and treatment can prevent life-threatening complications and increase the chance of future successful pregnancies.