A pregnancy that happens outside of the uterus is called an ectopic pregnancy. The uterus is the pear-shaped, hollow organ in a woman’s pelvis where a fetus (unborn baby) grows and develops. The uterus is also commonly called the womb, and its main function is to nourish developing fetuses before they’re born.
Pregnancy begins with a fertilized egg, which usually attaches to the lining of the uterus. When a fertilized egg implants and grows outside of the uterus (often in a fallopian tube, but sometimes in an ovary or the abdominal cavity), the pregnancy is ectopic.
Unfortunately, an ectopic pregnancy cannot proceed normally, and the fetus will not develop fully. Ectopic pregnancies can be dangerous for the mother if not immediately treated, and never result in the birth of a baby.
Ectopic pregnancies are medical emergencies. The uterus is designed to nourish and expand as the fetus grows. No other organ in the body can perform this function, including the fallopian tube or ovary. As the fertilized egg develops in the tube or ovaries, it can burst, which can cause large amounts of internal bleeding. This internal bleeding is life-threatening and needs immediate treatment to avoid injury to the fallopian tube, other nearby organs, and possible death.
“Ectopic pregnancies are one of the leading causes of death among women in the first trimester," said Olivia Higgins, MD, a minimally invasive gynecologic surgeon at the Center of Excellence in Minimally Invasive Gynecology at Rochester General Hospital. "If it is not caught early and managed appropriately, it can be catastrophic.”
Most ectopic pregnancies are discovered early in pregnancy–typically within the first trimester, or by the eighth week. Health care providers will perform several tests to confirm the pregnancy and then look for any signs of ectopic pregnancy. Tests may include:
Once a pregnancy is confirmed and it has been determined where the egg has been implanted, a personalized treatment plan will be created. Ectopic pregnancies are a medical emergency and treatment is key.
No, it is not. Unfortunately, an ectopic pregnancy is fatal for the fetus, as it cannot survive outside of the uterus. Quick treatment for an ectopic pregnancy is necessary to protect the mother’s life, and the fetus cannot be re-implanted in the uterus or elsewhere to continue growing.
Early symptoms tend to mimic the symptoms of pregnancy. The first warning signs are usually pelvic pain and light vaginal bleeding.
If blood is leaking from your fallopian tube or if it ruptures, you may experience additional symptoms including:
If you experience any of these symptoms with a positive pregnancy test, you should head to the nearest emergency room and reach out to your women’s health provider immediately, as this could indicate a medical emergency.
Treating an ectopic pregnancy ends your pregnancy. Sometimes, ectopic pregnancy treatments are confused with elective abortions, but with or without medical intervention, an ectopic pregnancy cannot progress past the first few months. If they continue, they risk rupturing a tube and causing catastrophic internal bleeding. A healthy birth is not possible with an ectopic pregnancy.
“The diagnosis of an ectopic pregnancy can be confusing and devastating for patients," Dr. Higgins said. "It is very important to treat this diagnosis with compassion and sympathy, making every attempt to understand the patient’s perspective. Then we must educate our patients on the seriousness of treatment and the need for continued follow up until complete resolution. This will help provide safety for the mother and any other future fertility.”
There are several ways to treat an ectopic pregnancy. They include medication or surgery.
Your provider will inject this medication to stop the growth of your pregnancy, ending it. This is a less invasive option than surgery but will require follow-up appointments to monitor your hCG levels to ensure you’re safe and healthy.
Laparoscopic surgery can be used to treat ectopic pregnancies. The two procedures used are salpingostomy or salpingectomy. In both, a small incision will be made near or in your navel. Your surgeon will use a thin tube capped with camera light and lens (called a laparoscope) to view your fallopian tubes.
If you are undergoing salpingostomy, the ectopic pregnancy will be removed, and the fallopian tube will be left to heal on its own.
If you are undergoing salpingectomy, both the tube and the ectopic pregnancy will be removed.
Your provider will determine which is right for you based on the damage to your tube, the amount (if any) of bleeding and whether your fallopian tube shows signs of previous damage.
If your fallopian tube has ruptured or if you are at risk of a rupture, surgery will be necessary. Medication is not the best option at this time. This life-saving and emergency treatment will involve removing the ectopic pregnancy from its incorrect implantation site, which sometimes involves removal of your fallopian tube.
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