Ectopic pregnancy: a practical guide

What is an ectopic pregnancy?

An ectopic pregnancy occurs when a fertilized egg implants and begins to grow outside the main cavity of the uterus. In most cases, this happens in one of the Fallopian tubes.

Since the tubes aren’t designed or equipped to support a growing embryo, the condition is considered a medical emergency and cannot lead to a viable pregnancy.

Unlike a typical pregnancy, an ectopic pregnancy poses significant health risks to the pregnant person, since the fertilized egg has neither space nor biological support for healthy growth.

If not treated promptly, it can cause internal bleeding, damage to reproductive organs, and, in rare cases, can be life-threatening. Early detection and medical intervention are essential to avoid some of the greatest complications.

Ectopic pregnancy: symptoms and diagnosis

Symptoms of an ectopic pregnancy can vary depending on the location in which the fertilized egg implants, but often include:

• Sharp or stabbing abdominal or pelvic pain.
• Vaginal bleeding different from a regular period.
• Shoulder pain: it may seem unrelated, but internal bleeding may cause irritation at the diaphragm and pain may irradiate all the way to the shoulders.
• Dizziness or fainting: these are often caused by internal bleeding.   

Diagnosis often involves a combination of a pelvic exam, blood tests to measure hormone levels, and imaging tests such as a transvaginal ultrasound to locate the misplaced egg. Prompt diagnosis is key to managing the condition safely, as it becomes increasingly dangerous as time passes.

Ectopic pregnancy: what to expect     

Being diagnosed with an ectopic pregnancy can be overwhelming and emotionally challenging, as it will most likely not lead to a viable pregnancy and may instead cause harm to the pregnant person; it can even pose life-threatening complications due to internal bleeding. Understanding what to expect can help you feel more prepared for the journey ahead:

Early warning signs

Early detection is critical for ectopic pregnancies. If detected and treated soon enough, this condition may not leave many physical repercussions.

Some of the first signs may resemble those of a normal pregnancy, such as a missed period, nausea, or breast tenderness. However, if you begin to experience any of the following, it's important to seek immediate medical attention:

• Pain in your lower abdomen: it may appear quickly or gradually, may be widespread or on one side, depending on the location of the fertilized egg.
• Vaginal bleeding: it may appear like your normal period but may also be lighter, heavier or darker than normal.
• Upset stomach or sudden diarrhoea: depending on the misplaced egg’s location, an ectopic pregnancy may have some symptoms resembling digestive issues.
• Pain when you urinate or defecate.
• Pain on the tip of your shoulders.

An ectopic pregnancy is a medical emergency and should be treated as such. It’s not an affection that can wait and will solve itself with time. In fact, the worst thing you can do is wait: the more you wait, the worse the prognosis.

Causes

The exact cause of an ectopic pregnancy may vary from case to case and depends on individual factors. However, it is often related to problems with the Fallopian tubes or pelvic area, which ultimately causes the egg to get stuck as it moves towards the uterus. Some of the factors include:  

• Inflammation of the pelvic area.
• A misshapen or otherwise irregular Fallopian tube.
• Previous surgery on the fallopian tubes or in the pelvic area.
• Hormonal imbalances   
• Abnormal development of the egg itself: sometimes the problem lies on the egg rather than on the tubes.
• Inflammation caused by infection: sexually transmitted infections, such as gonorrhoea or chlamydia, can cause inflammation in the tubes, which, in turn, increases the risk of an ectopic pregnancy.
• Cigarette smoking: there is a clear link between smoking and ectopic pregnancies. The more you smoke, the greater the risk.

Treatments

The treatment for ectopic pregnancies depends on how early they’re detected and the severity of the symptoms. The two main treatment options are:

• Medication (methotrexate): if caught on time, methotrexate stops the growth of the egg and allows the body to safely reabsorb it over time. This medication is administered via injection, but it’s only used when the pregnancy is caught early, and the fallopian tube hasn’t ruptured.
• Emergency surgical intervention: If the pregnancy is further along or the tube has ruptured, surgery is required to remove the ectopic tissue. In many cases, the affected fallopian tube may be removed to avoid further complications.

The importance of emotional support during an ectopic pregnancy

It is exceedingly rare, almost impossible, for ectopic pregnancies to come to terms. And as such, it is almost always equivalent to a pregnancy loss, which can be deeply upsetting.

An ectopic pregnancy not only affects the body but can also be a deeply negative emotional experience. Feelings of loss, confusion, guilt, and grief are completely normal. It’s important to seek emotional support as much as medical help.

Acknowledging your emotions and allowing yourself time to heal emotionally is a crucial part of the recovery process, particularly for women that want to have children. Remember, you are not alone, and support is available to help you navigate this difficult time.

It may also help to know that having an ectopic pregnancy does not automatically mean that you can’t have a successful pregnancy later on. Even with only one Fallopian tube, a woman has a good chance of getting pregnant again.

That said, it’s highly recommended to wait for a while after an ectopic pregnancy before you try to get pregnant again, since both body and mind require some time to heal after such a deeply negative experience.

Frequently Asked Questions

1. Does an ectopic pregnancy always happen in the Fallopian tubes?

No. While the vast majority of ectopic pregnancies do occur in the fallopian tubes, they can also happen in other locations such as the cervix, ovary, abdominal cavity, or even within a Cesarean section scar. These cases are significantly rarer, but also require prompt medical attention.

2. How soon after treatment for ectopic pregnancy can I try to get pregnant again?

This depends on the treatment you received. If you were treated with methotrexate, doctors usually advise waiting at least 3 months before trying to conceive again to allow the medication to leave your system. After surgery, recovery times may vary, but most people can try again after one full menstrual cycle. However, it’s better to ask your doctor about this before trying it again.

3. Is it possible to prevent an ectopic pregnancy?

While not all ectopic pregnancies can be prevented, reducing risk factors can help. This includes avoiding smoking, treating any sexually transmitted infections promptly, and discussing any fertility treatments or previous pelvic surgeries with your doctor.