In very early pregnancy, one of your worries may be finding out that the pregnancy is ectopic. But what is ectopic pregnancy, and what happens if you are found to have one? Let’s take a look at the symptoms, diagnosis, and treatment.
What is Ectopic Pregnancy?
In a normal pregnancy, a fertilized egg travels through the fallopian tube and attaches to the lining of the uterus. An ectopic pregnancy is when a fertilized egg attaches somewhere outside the uterus (1). You will still likely have a positive pregnancy test and may have other signs of pregnancy.
The most common place for an ectopic pregnancy is in the fallopian tubes, but it can implant in other places such as the abdomen, cervix, or ovaries (1, 2). About 2% of pregnancies implant outside the uterus (2). That’s certainly not common enough to lose sleep worrying about, but it is common enough that women should be aware of the signs and symptoms.
What are the Symptoms?
The symptoms of an ectopic pregnancy, some of which may occur even in a normal, healthy pregnancy, include:
- pelvic pain
- vaginal bleeding
- dizziness or light-headedness
- sharp pain in the shoulder
Most of these symptoms don’t necessarily indicate an ectopic pregnancy, but they do mean you should call your doctor or midwife. This is especially true if an ultrasound has not yet confirmed that your pregnancy is in the uterus.
Can you explain the shoulder pain?
But before we move on, let’s take a moment to discuss shoulder pain, because it seems out of place in the list of symptoms. As we’ll discuss in greater detail momentarily, an ectopic pregnancy can cause the fallopian tube to rupture. This may lead to bleeding in the abdominal cavity, which in turn irritates the diaphragm and causes a referred pain in the shoulder. The pain often increases when lying down and, ultimately may indicate internal bleeding (4).
Ectopic Pregnancy Risks
What are the risks to the mother?
Most cases of tubal ectopic pregnancy that are found early can be treated successfully with medication or minimally-invasive surgery (5). Still, an ectopic pregnancy is a serious situation. The diagnosis is not something that should send you into an immediate panic, but your doctor or midwife will want to act quickly. A growing embryo can cause a rupture in the fallopian tube. This could lead to internal bleeding, which, in a worst-case scenario, can lead to death.
An ectopic pregnancy can also risk a woman’s future fertility. Having one increases the risk of another due to damage in the fallopian tube. In some cases, they may need to remove the fallopian tube, which also affects future fertility. Be assured, though, that most women who have an ectopic pregnancy can expect to get pregnant again if they wish, and have a healthy baby (2).
What factors increase the risk of an ectopic pregnancy?
Your chances of having an ectopic pregnancy increase if you’ve had:
- A previous ectopic pregnancy
- Pelvic inflammatory disease (PID)
- A sexually transmitted infection (STI), or
- Tubal or abdominal surgery (3).
Ectopic pregnancy is still uncommon, so don’t panic if any of these situations apply to you. Just stay in communication with your healthcare provider and let them know if you have any of the symptoms.
Diagnosing Ectopic Pregnancy
Your doctor or midwife will do some tests if he or she suspects that your pregnancy may be ectopic. Blood or urine hCG tests are typically used to get some preliminary information. In a normal pregnancy, hCG increases rapidly; if hCG levels do not rise at the expected level, your provider may suspect an ectopic pregnancy (3). The next and most definitive step would be an ultrasound used to determine where an embryo has implanted.
Treatment for Ectopic Pregnancy
Unfortunately, an ectopic pregnancy is never viable, meaning that it will inevitably result in miscarriage. It is not possible for a pregnancy to grow and produce a healthy baby outside the uterus. And unfortunately, the embryo can not be moved; it will not implant again somewhere else. The goal of treatment is to remove the pregnancy quickly so that a woman’s fertility, health, and even life aren’t threatened.
Medication – Methotrexate
Medication, usually methotrexate, may be used to treat an ectopic pregnancy. This medication ends the pregnancy, and the cells are absorbed by the body. If a woman is given methotrexate, she should wait at least three months before she tries to get pregnant again (3). ACOG, The American College of Obstetricians and Gynecologists, has a great resource with a significant amount of information about methotrexate in ectopic pregnancy.
In some cases, an ectopic pregnancy will require surgery to remove the pregnancy. It will take place in the hospital under general anesthesia. Laparoscopy is the most common option, which means they’ll make small incisions and insert a slender camera and small instruments through them. Minimizing the size of the incision(s) means that you’re able to recover more quickly, though you will still need to take some time to recover.
Coping with Loss
An ectopic pregnancy is usually detected in weeks six to eight (2,3). This means you may have already known you were pregnant for as much as a month. You may feel shocked, sad, numb, or any combination of emotions. This is all normal for any loss of pregnancy. As I discussed in this post, I have personally experienced an ectopic pregnancy. I know the pain and sense of loss it can cause. Give yourself time to grieve and heal. Lean on family and friends. Consider talking to a therapist if you need to. And remember that your body is going through a number of changes and your hormones are running wild. Give yourself some extra rest, and be gentle with yourself as you recover, especially if you’ve had surgery.
And if the time comes that you try to conceive again, know that a full-term, healthy pregnancy is likely in your future, should you wish to try to get pregnant again.
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1. The American College of Obstetricians and Gynecologists. (2010). Your Pregnancy and Childbirth Month to Month, 5th edition.
2. Simkin, P. (2010). Pregnancy, Childbirth and the Newborn, 4th edition. Meadowbrook Press.
3. Glade, B.C., Schuler, J. (2011). Your Pregnancy Week by Week, 7th edition. First Da Capo Press.
4. Van de Ven J., Geomini, P.M. (2017). A pregnant woman with acute shoulder pain. Ned Tijdschr Geneeskd.
5. American College of Obstetrics & Gynecology. (2018). Practice Bulletin Number 193: Tubal Ectopic Pregnancy.