What You Should Know About Ectopic Pregnancies

Do you know how to recognize an ectopic pregnancy? Do you know that it’s the leading cause of first trimester maternal death? Fortunately, ectopic pregnancies (where a fertilized egg implants outside of the uterus) are rare in the United States, occurring in just 0.64% of all pregnancies [1]. Nevertheless, any sexually active woman should know the common signs and symptoms that might suggest that her pregnancy is not progressing normally.

As with normal pregnancy, early warning signs of extra-uterine pregnancy can include pelvic pain and vaginal bleeding. Syncope, which means dizziness, lightheadedness, or what’s often called “feeling woozy”, can indicate a problem, however, and this symptom is common in ectopic pregnancies. A sharp, stabbing pain in one side of the pelvis is also a common symptom of ectopic pregnancy. However, healthy women with normally developing fetuses can also experience dizziness, lightheadedness, pelvic pain, and even vaginal bleeding, so it’s important to be seen by a physician if you’re unsure whether your symptoms are normal.

Physicians have more tools than ever before to help diagnose and treat problematic pregnancies. After evaluating your symptoms, the doctor may order an exam called a transvaginal ultrasound. This type of ultrasound is performed by inserting a small probe into the vaginal canal so that the doctor can see the uterus and ovaries, as well as some surrounding tissue. In early pregnancy, a normally developing embryo or fetus will be located within the uterus. The earliest visual evidence of pregnancy that will be seen on ultrasound within the uterus is a yolk sac. At later stages, the fetus will be visible, including the sac surrounding the fetus. All normal pregnancies must be located in the uterus.

If a fertilized egg has begun to develop outside the uterus (most often this happens in the fallopian tubes), the yolk sac and surrounding fluid will be clearly visible during an ultrasound exam. Fallopian tubes are not designed to be stretched by a developing embryo, and they can be severely damaged if an ectopic pregnancy is not caught and treated in time. Therefore, if a transvaginal ultrasound detects an extra-uterine pregnancy, you will need further treatment to protect your health and your ability to have a normal pregnancy later on.

What type of treatment you receive will depend on how many weeks pregnant you are, and whether the ectopic pregnancy has already damaged your fallopian tubes. For ectopic pregnancies caught very early on, you may be able to take a type of drug called methotrexate which will help your body to absorb the fetal tissue. This will prevent damage to your fallopian tubes and hopefully avoid scarring them (which would make future ectopic pregnancies more likely). If the pregnancy has progressed so far that the fallopian tube has ruptured or caused internal bleeding, you may need surgery to remove the embryonic tissue and parts of the damaged fallopian tube. While this sounds frightening, it’s always better to receive this type of treatment because doctors can try to preserve the overall health of your fallopian tube, which makes future pregnancies more likely to be healthy. Women who do not receive timely treatments are at increased risk for complications and reduced future fertility.

All women, even those with no history of complications from pregnancy, should either seek emergency room care or contact a family practitioner immediately if they suspect an ectopic pregnancy. The fast, accurate diagnostic tools that are available today give women better chances than they’ve ever had to successfully recover from abnormal pregnancies and go on to have health babies.

Reference

[1] Menon S, Sammuel MD, Vichnin M, et al. Risk factors for ectopic pregnancy: a comparison between adults and adolescent women. Journal of Pediatric and Adolescent Gynecology 2007; 20:181-185.