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An ectopic pregnancy is a pregnancy that begins growing outside a woman’s uterus. It is not viable, which means the fetus cannot survive.
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Depending upon several different factors, your doctor may use medication or surgery to treat an ectopic pregnancy.
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More than 90% of ectopic pregnancies are in one of a woman’s fallopian tubes. This is sometimes called a tubal pregnancy.
Whether you were planning to become pregnant or not, an ectopic pregnancy can be quite traumatic and emotional. It often leads to surgery, and it always requires intervention from your doctor so you can prevent potentially dangerous complications.
We talked to Loren Castellon, M.D., a Providence obstetrician and gynecologist who treats patients in Los Angeles, California, about ectopic pregnancy. She shared more about what it is, how it’s treated and whether it can affect future pregnancies.
What is an ectopic pregnancy, and what are the risk factors?
An ectopic pregnancy (also known as an extrauterine pregnancy) is one in which the fertilized egg implants and begins growing anywhere in a woman’s body that is not the uterus, including the fallopian tubes, ovaries or cervix. However, more than 90% of ectopic pregnancies occur in a fallopian tube — a situation that is called a tubal pregnancy.
Although any woman can experience an ectopic pregnancy, there are a few risk factors that can make a woman more susceptible to it. “The most common risk factor is if you’ve had it before,” says Dr. Castellon. “There is about a 10% future risk of a future ectopic pregnancy after having had one. Other risk factors can include any condition or disease process that affects the fallopian tubes. Sexually transmitted infections (STIs) such as chlamydia or gonorrhea can damage the fallopian tubes in a condition called pelvic inflammatory disease (PID). Scar tissue from PID damages the fallopian tubes, which can make ectopic pregnancy more likely.”
According to the American College of Obstetricians and Gynecologists (ACOG), other risk factors for ectopic pregnancy include:
- Smoking cigarettes
- Being older than 35
- Having a history of infertility
- Using assisted reproductive technology, such as in vitro fertilization (IVF)
Signs and symptoms of ectopic pregnancy
An ectopic pregnancy may seem like a typical pregnancy at first, with normal symptoms such as:
- A missed period
- Mild abdominal pain and cramping
- Tender breasts
- Upset stomach
“Those are signs you may notice when you’re pregnant,” says Dr. Castellon. “However, if you start experiencing vaginal bleeding or sharper pelvic pain, you should be evaluated by a medical provider.”
As an ectopic pregnancy progresses, symptoms can become more severe, and even life-threatening for the mother. That’s why it’s so important to seek care as soon as you suspect something is wrong.
“The uterus is designed to continuously grow and expand with the pregnancy,” says Dr. Castellon. “Any time a pregnancy is outside the uterus, that tissue is not meant to expand. And because the tissue that is attached to the developing embryo is not meant to sustain the pregnancy, eventually this leads to rupture and internal bleeding.”
Treatment for ectopic pregnancy
An ectopic pregnancy is always nonviable, which means the fetus will not survive because it cannot be moved to the uterus. That means that you and your doctor have two choices for treatment options: medication or surgery.
Medication
Doctors most commonly use a drug called methotrexate for medical treatment of an ectopic pregnancy. The drug stops the fetus from growing, which causes the pregnancy to be absorbed into your body over the next four to six weeks. However, medication can only be used when the pregnancy has not ruptured a fallopian tube. If you have a ruptured ectopic pregnancy, then emergency surgery is the only option.
Surgery
Surgery is a common treatment for ectopic pregnancy. “The decision for surgery involves how big the ectopic pregnancy is, where it’s located and how high your pregnancy hormone is,” says Dr. Castellon.
During the laparoscopic surgery, your doctor will put you to sleep and insert a lighted camera through a small incision in your abdomen. They will then insert surgical instruments, which they will use to remove the fetus. “As most ectopic pregnancies are in the fallopian tube, surgical treatment typically is a salpingectomy, which is the removal of the affected fallopian tube,” says Dr. Castellon.
Dr. Castellon adds that it is important to remove the fetus as quickly as possible, because the longer it grows outside a woman’s uterus, the more it can endanger her health.
Can having an ectopic pregnancy affect future pregnancies?
Many women who have an ectopic pregnancy go on to have one or more successful pregnancies. However, Dr. Castellon points out, a history of previous ectopic pregnancies can be a risk factor for a future such pregnancy. “If your fallopian tube is damaged, you are at a higher risk of having an ectopic in that same spot,” she says. “But the more common outcome is a pregnancy implanted in the uterus.”
“Seeking treatment for an ectopic pregnancy does not mean you will suffer infertility,” Dr. Castellon adds. “You do have another fallopian tube, so there is still the possibility of conceiving.”
If you think you might be experiencing an ectopic pregnancy, call your doctor right away. If the pain or bleeding is severe, head to the nearest emergency room.
Contributing caregivers
Loren Castellon, M.D., is a Providence obstetrician and gynecologist who treats patients in Los Angeles, California.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.
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