What Happens If You Have an Ectopic Pregnancy

Every month, one of your ovaries releases an egg into a fallopian tube. If you don’t become pregnant, the lining of your uterus sheds and your period arrives. But if an egg becomes fertilized with sperm, it makes its way to the uterus and implants into the uterine lining and continues to develop into a fetus. 

In approximately 2 percent of all pregnancies, however, a fertilized egg implants outside of the uterus, usually in a fallopian tube. Known as an ectopic pregnancy, it happens early on — before some women even realize they’re pregnant. And it requires prompt treatment: As an ectopic pregnancy grows, it can rupture the fallopian tube and cause life-threatening internal bleeding. 

The good news? With a timely diagnosis and care, it is possible that you can have a healthy pregnancy in the future.

What is an ectopic pregnancy?

An ectopic pregnancy (also known as a tubal pregnancy) is when a fertilized egg implants outside of the uterus, where it can’t continue to develop normally. About 2 percent of all pregnancies are ectopic. And more than 90 percent of ectopic pregnancies occur in one of the fallopian tubes, though they can also happen in the cervix, on an ovary or in the abdomen. 

If the ectopic pregnancy goes unnoticed and continues to grow, it can rupture a fallopian tube and cause severe bleeding. That’s why it’s essential to call your doctor right away if you think you’re experiencing ectopic pregnancy symptoms.

What are early signs and symptoms of ectopic pregnancy?

Symptoms of ectopic pregnancy develop between weeks 4 and 12 of pregnancy (or about two to 10 weeks after fertilization). However, ectopic pregnancy can be hard to diagnose since many signs  — including breast tenderness, nausea and fatigue — are similar to normal early pregnancy symptoms. 

Occasional cramping and slight vaginal spotting are not cause for alarm during pregnancy. But you should contact your practitioner if you experience the following signs of ectopic pregnancy, especially if your symptoms persist or worsen:

• Abnormal light bleeding or brown spotting after a positive pregnancy test
• Other vaginal bleeding that doesn’t occur at the time of your period
• Sharp, crampy abdominal pain, usually in the lower abdomen. iIt often begins as a dull ache that progresses to spasms and cramps. The pain may be continuous or intermittent, and it may worsen when you move, strain your bowels or cough.
• Lower back pain

If the ectopic pregnancy goes unnoticed and a fallopian tube ruptures, you may experience:

• Heavier bleeding
• Increasing and/or severe sharp abdominal pain
• Rectal pressure
• Low blood pressure due to blood loss
• A feeling of faintness, weakness or dizziness due to blood loss
• Shoulder pain, due to the accumulation of blood under the diaphragm

What are the causes of ectopic pregnancy?

Ectopic pregnancies often occur because an egg’s movement is slowed or obstructed after fertilization, usually because a fallopian tube is scarred, misshapen or possibly infected or inflamed. Problems with the development of the fertilized egg or hormonal imbalances may also play a role.

What are the risk factors for ectopic pregnancy?

Although any woman can develop an ectopic pregnancy, the following conditions are linked with an increased risk of ectopic pregnancy:

• Pelvic inflammatory disease
• Sexually transmitted infections (STI) like chlamydia or gonorrhea
• Prior ectopic pregnancy. A woman who's experienced one ectopic pregnancy has about a 10 to 15 percent chance of having another.
• Endometriosis
• Fertility treatments such as in vitro fertilization
• Tubal surgery, including tubal ligation, or having your tubes tied
• Getting pregnant while using an intrauterine device, or an IUD. Using an IUD does not increase your risk of an ectopic pregnancy later on, and an ectopic pregnancy with an IUD is extremely rare — but if you do conceive with an IUD in place, your risk of ectopic pregnancy is higher.
• Smoking
• Being over the age of 35

If you’re at increased risk for an ectopic pregnancy, be sure to see your doctor before you start trying to get pregnant, and schedule a visit as soon as you find out you’re expecting.

Ectopic pregnancy tests and diagnosis

A pregnancy that's ectopic is usually diagnosed at about four to six weeks into pregnancy. Ectopic pregnancy tests and diagnosis often include:

• A pelvic exam
• A transvaginal ultrasound, which can pick up an ectopic pregnancy as early as five weeks after your last menstrual period; a wand is placed inside your vagina to check for a developing embryo outside of the uterus.
• Blood tests to check the level of the hormone human chorionic gonadotropin (hCG), the hormone made by the placenta that increases during pregnancy. A lower-than-normal increase in hGC levels may indicate an ectopic pregnancy.
• Other blood tests to check for signs of blood loss

Ectopic pregnancy treatment

Unfortunately, there’s no way to preserve an ectopic pregnancy. There are several options to treat it, all of which require careful follow-up with your doctor to ensure your hCG levels drop back down to zero.

Medication

The smallest ectopic pregnancies — where a fetal heartbeat isn’t present and a fallopian tube hasn’t ruptured — can usually be treated with methotrexate. The drug keeps cells from growing, so the pregnancy ends and is reabsorbed by the body over four to six weeks. 

Following a shot of this medication, you’ll undergo important follow-up blood tests to ensure hCG levels are decreasing appropriately. If your hCG level does not drop by at least 15 percent between the fourth to seventh day after treatment, a second dose is required. 

It’s important to avoid alcohol, folic acid (in both vitamins and foods) and pain medications like ibuprofen to ensure the medication works correctly, as well as heavy exercise and sex (for at least two weeks). During the process, the ectopic pregnancy can still rupture, which is why it’s so important to make sure to make your doctor’s appointments and follow his or her instructions for follow-up care. 

Laparoscopic surgery

In most other cases, including when a fallopian tube has ruptured or the pregnancy is further along, your practitioner may perform surgery under general anesthesia to remove an ectopic pregnancy. Women usually leave the hospital within 24 hours after a laparoscopy, and the recovery time is a week or two.

The surgery can be done using a laparoscope (a thin, light-transmitting instrument with a camera) that’s inserted through small incisions in the abdomen. It allows surgeons to see inside without having to make larger incisions while surgical instruments are used. In some cases where the fallopian tube has ruptured, part or all of it may need to be removed. 

Laparotomy

Sometimes a bigger incision is needed to treat an ectopic pregnancy. In this case, you’d leave the hospital in a day or two, and your recovery time would be about six weeks.

Ectopic pregnancy complications

Without early diagnosis of an ectopic pregnancy and treatment, a fertilized egg can continue to grow in the fallopian tube, leading to a rupture. If a fallopian tube bursts, it can't carry a fertilized egg to the uterus in the future. And if a rupture is uncared for, it can result in severe internal bleeding and shock.

The good news is that with early detection and medication or surgery, doctors can remove the tissue before these complications occur — so always be sure to let your practitioner know right away if you’re experiencing any symptoms you think may be related to an ectopic pregnancy.

Preventing ectopic pregnancy

Although some factors are out of your control, there are a few ways you can decrease your risk of ectopic pregnancy:

• Don’t smoke.
• If you're not currently trying to get pregnant, use condoms to lower your risk of contracting an STI. 
• Get tested if you are at risk of contracting an STI, so you can get treated promptly.
• See your doctor for possible treatments if you suffer from endometriosis.

And of course anytime you’re trying to get pregnant, the best way to stay healthy is to exercise, eat well and remember to take a daily prenatal vitamin. 

Coping with pregnancy loss

Although it occurs early on, an ectopic pregnancy is a loss just like any other miscarriage — especially if you’ve been planning for a child. You may feel sad or shocked, and healing emotionally can take time. Lean on your friends and family for support following a pregnancy loss, and consider a support group or grief counseling.

Getting pregnant again after ectopic pregnancy

Having an ectopic pregnancy should have little bearing on your future fertility. Even if you lost a fallopian tube, the other tube should take over. 

Some research has shown that about two-thirds of women treated for ectopic pregnancy conceive and have a normal pregnancy within two years. On average, about 85 percent of couples who haven't experienced ectopic pregnancy conceive within one year of trying.

Be aware that having one ectopic pregnancy does increase your risk of having another, and the same factors that led to it in the first place may be still at work.

If you’d like to try and get pregnant again, make sure to see your practitioner for a checkup and follow-up blood tests first to make sure the pregnancy hormone hCG has dropped to an undetectable level. It may be a good idea to wait until you’ve had three to six menstrual cycles before trying to get pregnant again.