Ectopic pregnancy, where the embryo grows outside the womb, is fatal and a primary cause of pregnancy-related deaths during the first trimester.1
It’s no secret that pregnancy is a precious experience. Yet, like all things related to health, pregnancies can run into problems. Let’s take it back to the basics. In a normal pregnancy, the egg is fertilized in the fallopian tube. Then, it travels down to the uterus and attaches to the lining of the uterus in a process called implantation. If the egg is blocked or slowed down, implantation can happen outside the uterus. The outcome is an ectopic pregnancy, a fatal complication for the mother and almost always death for the embryo. If you’re planning on getting pregnant, it’s important to be aware of the causes and symptoms of ectopic pregnancy.
Sites Of Ectopic Pregnancy
Over 98% of ectopic pregnancies occur in some part of the fallopian tube. Very rarely, the egg may implant itself in the abdomen, ovary, or even a C-section scar.
If the egg isn’t in the uterus, where does it go? More than 98% of ectopic pregnancies happen in some part of the fallopian tube including:
- Ampulla: the part that curves above the ovary
- Isthmus: bordering the ampulla
- Fimbria: finger-like projections at the end of the fallopian tube
Sometimes, the embryo ends up in a part of the fallopian tube that penetrates the muscular layer of the uterus, leading to interstitial or cornual ectopic pregnancy. Interstitial pregnancies are rare but riskier. In fact, their mortality rate is twice as much as any other fallopian tube ectopic pregnancy.
In very rare cases, an ectopic pregnancy may implant in locations outside the fallopian tubes, such as the abdomen, liver, spleen, cervix, ovary, or even a Cesarean section scar.2
7 Causes And Risk Factors Of Ectopic Pregnancy
Ectopic pregnancy can be caused when the fertilized egg cannot pass easily into the uterus and attaches to other areas. Any condition affecting the fallopian tubes raises the risk of ectopic pregnancy. But in many cases, no discernible risk factor can be found.
In this condition, the tissue lining the inside of the uterus grows on the outside of the uterus and on the bladder, ovary, bowel, or fallopian tubes. The tissues hinder the easy passage of the fertilized egg.
2. Fallopian Tube Defects
Birth defects in the mother’s fallopian tubes are a risk factor for ectopic pregnancies. These defects were common in women whose mothers had been exposed to the hormonal drug DES (diethylstilbestrol) till the 1970s to prevent miscarriage. While the FDA discontinued DES in the U.S. in 1971, it was still used in other countries.3
3. History Of Ectopic Pregnancy
If one has already had an ectopic pregnancy, it is possible the causes still exist. This is why the doctor should keep an eye out for complications in future pregnancies. Tests and scans might be done in order to rule out another ectopic pregnancy.4
You cannot control most risk factors of ectopic pregnancy. But you can practice safe sex to prevent STDs, stop smoking, and treat scar tissues after surgery.
Surgery of the fallopian tubes, tying up the fallopian tubes (tubal ligation) to prevent pregnancy, and opening the tied up tubes can all affect the fallopian tube’s ability to help passage of the egg. Cesarean section, removal of abnormal ovarian cysts, removal of the appendix, or bowel procedures can also form scars tissues or adhesions in the reproductive system. These adhesions block the journey of the egg toward the uterus.
Past genital infections such as pelvic inflammatory disease and salpingitis or the inflammation of the fallopian tubes caused by the sexually transmitted diseases gonorrhea or chlamydia increase the risk of ectopic pregnancies.
6. Hormonal Imbalance
Factors affecting the hormone levels include some infertility treatments and being older than 35. If one got pregnant despite using contraceptives like an intrauterine device (IUD) or progesterone-only pills, there’s a higher risk of it being an ectopic pregnancy.5
Abortion is not a risk factor for ectopic pregnancy.
Smoking alters the structure and function of the fallopian tube by altering the expression of the gene PROKR1. This gene regulates the contractions of smooth muscles and implantation within the uterus. The change in gene expression affects the fallopian tube’s ability to help the egg travel to the uterus.6
8. In Vitro Fertilization (IVF)
While around 1% of all natural pregnancies are ectopic, artificial methods of fertilization, such as in vitro fertilization can raise the number to 5%.7 This is possibly because a number of embryos are transferred together during IVF. While nowadays the risk is lower since the embryo is guided accurately to the best possible location in the uterus, the possibility of an ectopic pregnancy cannot be entirely ruled out.
7 Symptoms Of An Ectopic Pregnancy
Often, an ectopic pregnancy terminates within a few days of conception, and you may experience only mild symptoms. If it carries on, the early symptoms of an ectopic pregnancy are often same as the signs of a regular pregnancy, such as nausea, breast soreness, and fatigue. If the pregnancy continues longer, there’s a risk of rupture of the fallopian tube, and the symptoms are severe. Some of these may resemble those of gastroenteritis, miscarriage, or appendicitis. Here’s a look at the more serious symptoms of an ectopic pregnancy:
1. Vaginal Bleeding
Vaginal bleeding or spotting is one of the first signs of an ectopic pregnancy. As the pregnancy progresses, the growing embryo can damage the fallopian tube or wherever it is lodged and increase the bleeding. The blood may be red, brown or black, and watery. It’s important not to confuse this with a delayed period. Untimely bleeding, prolonged light bleeding, or sudden heavy bleeding needs to be investigated immediately. Sometimes, the mother can go into shock in case of heavy internal bleeding.8
2. Abdominal And Pelvic Pain
The initial symptoms of an ectopic pregnancy may be experienced by 6 weeks from your last period. A pregnancy test at home may not confirm the pregnancy. If the symptoms aggravate to one-sided abdominal pain, bloating, and vaginal bleeding or spotting, it’s essential to visit a doctor.
Pain in the lower abdomen or the pelvic area, especially on one side, is a symptom of ectopic pregnancy. The pain may be dull or sharp and will increase with movement, passing stool, or coughing – anything that puts pressure on your abdomen. You may also experience a sense of bloating and heaviness when lying down. This is especially seen in women who have had a child before.9 If the area around the implantation ruptures, you would experience sharp pain and cramps.
3. A Bad Backache
While pain in the lower back is common during early pregnancy, pain on one side can be caused by ectopic pregnancy.
4. Shoulder Tip Or Neck Pain
Shoulder tip pain can be a distinguishing factor in diagnosing ectopic pregnancy or miscarriage, as opposed to appendicitis. However, all three conditions require immediate medical attention.
Pain the neck and/or shoulder tip is often the distinguishing symptom indicating that the ectopic pregnancy has ruptured or miscarried. It is because of internal bleeding that irritates the diaphragm. This type of pain is quite unlike that caused by bad posture. The pain may begin suddenly and may often be accompanied by a general sense of discomfort, abdominal pain, or vaginal bleeding.
5. Pressure In The Rectum And Change In Bowel
Intense pressure in the rectum or the abdominal area that feels like gas pain should not be ignored. Often internal bleeding from the ruptured site of pregnancy puts pressure on these areas. Pain while passing urine or stool as well as a change in bowel movement can also be symptoms of an ectopic pregnancy.
6. Sudden Drop In Blood Pressure
A sudden drop in blood pressure, along with cold clammy skin and sweating, is a sign of the body going into shock due to heavy internal bleeding due to the rupture of the fallopian tube or wherever the embryo is latched. If this happens, the patient needs immediate medical attention.
Sharp pain in one side of the abdomen, shoulder pain, and suddenly falling blood pressure during pregnancy indicate a ruptured ectopic pregnancy. Seek your OB-GYN’s help immediately.
7. Feeling Faint And Dizzy
Dizziness and the feeling of faintness are both a result of the low blood pressure caused by rupture in the site of pregnancy. These are symptoms of shock and must not be neglected.
Slow Rise Of hCG Can Indicate Ectopic Pregnancy
Fortunately, early detection of an ectopic pregnancy is totally possible. It calls for a transvaginal ultrasound and a test of the woman’s blood human chorionic gonadotropin (hCG) levels. This hormone, which is produced by the placenta after embryo implantation, shows up pretty early in pregnancy and doubles every 3 days for the first 8–11 weeks. If a blood test finds that hCG levels aren’t rising fast enough, an ectopic pregnancy is suspected.10
Treatment For Ectopic Pregnancy
Sometimes, the best way forward can be to monitor the pregnancy closely. It may resolve on its own. In advanced stages, treatment options include surgery and chemotherapy. Several factors like the age of the embryo and the mother’s health profile will determine whether surgery or chemotherapy is the way forward. Those looking at alternative health can treat ectopic pregnancy by balancing vata dosha with ayurvedic methods. While ectopic pregnancy is physically and mentally exhausting, it is possible to have a healthy pregnancy after an ectopic pregnancy.
|↑1||Cecchino, Gustavo Nardini, Edward Araujo Júnior, and Julio Elito Júnior. “Methotrexate for ectopic pregnancy: when and how.” Archives of gynecology and obstetrics 290, no. 3 (2014): 417-423.|
|↑2||Sivalingam, Vanitha N., W. Colin Duncan, Emma Kirk, Lucy A. Shephard, and Andrew W. Horne. “Diagnosis and management of ectopic pregnancy.” Journal of Family Planning and Reproductive Health Care (2011): familyplanning73.|
|↑3||About DES. Centers For Disease Control and Prevention.|
|↑4||Ectopic Pregnancy. U.S. National Library Of Medicine.|
|↑5||Sivalingam, Vanitha N., W. Colin Duncan, Emma Kirk, Lucy A. Shephard, and Andrew W. Horne. “Diagnosis and management of ectopic pregnancy.” Journal of Family Planning and Reproductive Health Care (2011): family planning 73.|
|↑6||Horne, Andrew W., Jeremy K. Brown, Junko Nio-Kobayashi, Hazirah BZ Abidin, Zety EHA Adin, Lyndsey Boswell, Stewart Burgess, Kai-Fai Lee, and W. Colin Duncan. “The association between smoking and ectopic pregnancy: why nicotine is BAD for your fallopian tube.” PLoS One 9, no. 2 (2014): e89400.|
|↑7||In Vitro Fertilization: IVF. American Pregnancy Association.|
|↑8, ↑9||Symptoms of Ectopic Pregnancy. The Ectopic Pregnancy Trust.|
|↑10||Human Chorionic Gonadotropin (hCG): The Pregnancy Hormone. American Pregnancy Association.|