What is an Ectopic Pregnancy?

As access to reproductive healthcare has been restricted, especially in the United States (Roe v. Wade was overturned on June 24, 2022), there has been more discussion about what constitutes a viable pregnancy. The term ectopic pregnancy is often used as an example of a condition that may require lifesaving reproductive treatment and is often cited as an example as to why access to such healthcare should remain prevalent and, critically, legal. But what exactly is an ectopic pregnancy? And why does it require treatment that ultimately results in the termination of that (often wanted and planned for) pregnancy?

What is an ectopic pregnancy?

When an egg is ovulated (released from the ovary), it travels toward and into one of the fallopian tubes. This is where it meets up with the sperm and becomes fertilized. From there, this early embryo divides rapidly over a course of several days (reaching several hundreds of cells by the time it becomes a blastocyst) and travels the remainder of the journey through the fallopian tube to the uterus where it will hopefully implant and ultimately grow into a fetus. If that embryo, once formed, implants anywhere other than the uterus, it’s called an ectopic pregnancy (ectopic literally means “in an abnormal place”). Up to two percent of clinical pregnancies are ectopic and the most common location of one (94 percent of cases) is in one of the fallopian tubes, though it can also be in the cervix or, even more rare, on the ovaries or within the abdomen. Since the fetus and placenta need the uterus and uterine lining to grow and thrive, attempting growth anywhere else will not support them. Bottom line? An ectopic pregnancy is a non-viable pregnancy.

What are the signs of an ectopic pregnancy?

Clinically, after getting a positive pregnancy test, your beta-hCG (the pregnancy hormone) should double every two days. If your levels rise slower than this, it could suggest either an ectopic pregnancy or early pregnancy loss and will have to be investigated with an ultrasound. In fertility clinics, the beta-hCG levels are monitored closely, and slow rising levels are a trigger for closer surveillance including an early obstetrical ultrasound.

 When an ectopic pregnancy is more advanced it can cause symptoms (most commonly around six to nine weeks gestation) like vaginal bleeding or pelvic pain (occurring in 88 percent of cases). Other symptoms occasionally include vomiting, diarrhea, and fainting.  Anyone experiencing vaginal bleeding or lower abdominal or pelvic pain in early pregnancy should be assessed for an ectopic pregnancy, although these symptoms can also be present in a normal pregnancy (within the uterus) as well.

Why is an ectopic pregnancy so dangerous?

The biggest risk of an ectopic pregnancy is the rupture of a fallopian tube and associated internal bleeding. An ectopic pregnancy represents a dangerous medical situation because there is a high chance that as the pregnancy progresses the fallopian tube will rupture and cause internal bleeding. The internal bleeding associated with a rupture is significant (these are large blood vessels) and requires surgical intervention to stop it. It’s a life-threatening condition and requires immediate medical care, and it’s critical to identify ectopic pregnancies early. In the past, ectopic pregnancies were one of the most common causes of pregnancy-related deaths because they were not identified until the situation was dire.

Can you prevent an ectopic pregnancy?

Where an embryo decides to implant is out of your control. However, there are certain factors that can increase the risk of having an ectopic. They can include:

Smoking and nicotine use

Cigarette smoking and nicotine use are major risk factors for ectopic pregnancy. The normal journey of the embryo through the fallopian tube is facilitated by contractions of smooth muscle in the walls of the tube, as well as the sweeping action of tiny hair-like structures that line the inside of the tube, called cilia. Cotinine, which comes from nicotine, is a chemical that turns specific fallopian tube genes on and off, changing the structure of the fallopian tube’s cells and decreasing their function. When the fallopian tube doesn’t function as it should, the embryo can’t travel very well, and by the time it becomes a blastocyst and hatches, if it’s still within the fallopian tube it can implant, resulting in an ectopic pregnancy.

IUD use

It’s rare to get pregnant while you have an IUD inserted (less than one percent). But, if a pregnancy does occur with an IUD (copper or hormonal), there’s a 53 percent chance it will be an ectopic pregnancy. An IUD prevents an embryo from implanting into the uterus, so if there is a pregnancy it’s far more likely to be in the fallopian tube.

Other risk factors

• Being over 35 years of age
• Any infection that may have spread up the uterus and impacted the inside of the fallopian tubes, like pelvic inflammatory disease caused by STIs
• Any scar tissue that might form around the outside of the fallopian tubes causing distortion or narrowing like previous pelvic surgery, ruptured appendix, advanced-stage endometriosis

How do you treat an ectopic pregnancy?

How an ectopic pregnancy is treated will depend on the location of implantation and how much damage has been caused. It’s possible that an ectopic pregnancy resolves on its own (called tubal abortion) but this is not common, and given how serious an ectopic pregnancy is the watch-and-wait approach is not the recommended course of action. If the fallopian tubes are still intact and the implanted tissue is still very small, you might be given medication (an injection called methotrexate). It stops the action of folic acid which is required in all cells. It works similarly to a chemotherapy drug that targets fast dividing cells, which in this case would be the ectopic pregnancy. This medical approach is most effective in the early stages of an ectopic pregnancy (when beta-hCG levels are lower). Diagnosing an ectopic pregnancy early will allow you more choices for treatment.

 But most ectopic pregnancies will require surgery, which has a higher success rate than methotrexate. Tissue has implanted and is growing where it’s not supposed to, so the ectopic pregnancy may have to be surgically removed, which includes potentially removing the affected fallopian tube. If the tube has already ruptured, immediate surgical attention will be needed to stop any internal bleeding.

 With an ectopic pregnancy, timing is crucial when it comes to treatment.

Why do we hear about it in relation to abortion rights and access?

Since ectopic pregnancy treatment and management falls under the category of reproductive healthcare, many people are worried about what to do if they suspect an ectopic and if they will legally have access to medical care. Murky anti-abortion legislative wording also has medical doctors unsure of which types of treatments they can provide without being prosecuted or losing their licence.

An ectopic pregnancy won’t be able to grow into a viable baby, however, it is still considered a pregnancy that’s progressing. The embryo implanted—not where it was supposed to, but it did find a landing spot where those cells are dividing and growing. There would have been a positive pregnancy test and elevated beta-hCG levels consistent with pregnancy. Treating an ectopic pregnancy includes terminating that pregnancy—A.K.A., abortion. Crucially, legislation may prevent the use of methotrexate to treat an ectopic pregnancy since this drug can be used for elective abortions, though most medical abortions use different medications. A chief worry about new and restrictive reproductive healthcare laws is that (depending on where you live), doctors or hospitals may delay care until the situation is critical (to comply with the law), often leading to a ruptured fallopian tube which would affect future fertility, and cause internal bleeding, tissue damage, and very possibly death.

You have the right to ask for medical help. If you think you’re experiencing an ectopic pregnancy, see your doctor or get emergency care immediately. Do not wait—if you are experiencing an ectopic pregnancy, the more advanced it is the more dangerous it is. If a practitioner is hesitant to treat you based on anti-abortion laws, do what you can to find another doctor and get another opinion. The fact is ectopic pregnancies are non-viable, life-threatening pregnancies and require emergency care.