What is an ectopic pregnancy? - explainer

Ectopic pregnancies are potentially life-threatening complications that almost always result in the death of the fetus. Here is what you need to know about it.

 The fallopian tube, where most ectopic pregnancies take place (Illustrative). (photo credit: Wikimedia Commons)
The fallopian tube, where most ectopic pregnancies take place (Illustrative).
(photo credit: Wikimedia Commons)

An ectopic pregnancy is a pregnancy complication that causes severe pain, almost always results in the death of a fetus and, if untreated, can kill the mother.

Ectopic pregnancies are seen all over the world and were first described by Medieval Arab surgeon Al-Zahrawi in the 11th century. 

Though there are treatments available for it, there are fears that, due to the US Supreme Court overturning Roe v. Wade and abortion being banned in several states, many women and people who give birth may be unable to get the treatment needed.

Here is everything you need to know about ectopic pregnancy.

What is ectopic pregnancy?

Essentially, an ectopic pregnancy is when a fertilized egg grows outside the uterus's main cavity.

A colored drawing of female anatomy depicting a uterus, fallopian tubes and ovaries. Menstruation, monthly period (Illustrative) (credit: FLICKR)A colored drawing of female anatomy depicting a uterus, fallopian tubes and ovaries. Menstruation, monthly period (Illustrative) (credit: FLICKR)

This usually occurs in the fallopian tube - though that type of ectopic pregnancy is known as a tubal pregnancy - but it can occur elsewhere, like the abdominal cavity, the cervix or even ovaries.

What are early warning signs of ectopic pregnancy?

At first, it might not be evident if you have it as all the normal pregnancy signs and symptoms will be there. You'll miss your period, experience nausea and a pregnancy test will come out positive. 

But when you start experiencing pelvic pain and some light vaginal bleeding, that should be a sign that things might not be normal.

Shoulder pain and bowel movement urges are also signs of blood leaking from the fallopian tube, but overall, most early warning symptoms will vary depending on the nerves involved and where blood is collecting.

What are ectopic pregnancy symptoms?

Overall, the shoulder pain and vaginal bleeding are already signs that you should see a doctor, according to the Mayo Clinic. Other symptoms also include pain and discomfort when urinating or defecting.

But there are other symptoms. These include sharp, sudden and intense abdominal pain, fainting and extreme dizziness and lightheadedness and looking very pale. These aren't just signs of an ectopic pregnancy - these are signs that the pregnancy has gone so large that it has literally caused the fallopian tube to rupture by splitting it open.

This is an extremely serious condition as the bleeding can be life-threatening and requires immediate surgery.

Can a baby survive an ectopic pregnancy?

The answer is almost always no. 

Ectopic pregnancies are not viable, in principle, as the fetus is not properly attached to the walls of the uterus as it is supposed to but is rather ectopic, meaning "out of place." 

The fertilized egg will continue to grow but it won't survive. But its continued growth is still life-threatening for the mother.

It should be noted, though, that it is still technically possible to survive an ectopic pregnancy, with one recorded instance having happened in the United Kingdom in 1999.

As reported by The Guardian at the time, 32-year-old Jane Ingram was pregnant with triplets, two girls and one boy. But while the girls developed inside the uterus, the boy's fetus was trapped inside the fallopian tube. Despite this, the fetus was able to survive by attaching itself outside the uterus and getting linked to the blood supply.

There was still danger, though, as while the baby was technically viable in that state, they still needed to perform a C-section at 29 weeks because the fetus could have caused a rupture at any moment.

But this is the exception, and the odds of this occurring naturally are astronomical.

Further, there isn't a way for doctors to intervene and save an ectopic fetus, as doing so would require essentially putting the fetus inside the uterus, and that isn't physically possible given the current technology at our disposal.

Is an ectopic pregnancy a miscarriage?

Technically no, at least not necessarily.

An ectopic pregnancy is a very specific circumstance and condition.

A miscarriage is when the fetus dies in the uterus within the first half of pregnancy. By contrast, a stillbirth is when the fetus dies in the latter half, though they are still classified as miscarriages.

Technically, an ectopic pregnancy can result in a miscarriage, but they are not inherently the same thing.

How common is ectopic pregnancy?

It's pretty rare, but it does happen. Worldwide, they average at around 1.5% of live births. In the UK, one out of every 90 pregnancies is ectopic, according to the UK's National Health Service (NHS). That still comes up to tens of thousands, if not more, around the world each year.

But there are risk factors.

For one thing, anyone who has had an ectopic pregnancy before has a 10% higher risk of having another. The risk is also raised for some fertility treatments and for prior fallopian tube surgery.

But aside from that, there is also inflammation caused by sexually-transmitted diseases such as chlamydia, smoking, increasing age (35-40) and getting pregnant while with an IUD. 

Regarding the latter, an IUD, which is meant to prevent pregnancy, in of itself does not make one more likely to have an ectopic pregnancy in the future. However, if you somehow get pregnant while you still have an IUD, something there is already a low probability for, then it may be far more likely to be ectopic.

It should be noted that having gotten an abortion before does not make one more likely to have an ectopic pregnancy.

But despite the fact that we know these risk factors exist, none are ever identified in as many as 33%-50% of all ectopic pregnancy cases, according to several studies.

How to prevent ectopic pregnancy?

There are a few small steps. Don't smoke or, if you are, quit smoking before trying to get pregnant. Use condoms and avoid sexually-transmitted diseases

However, these will just reduce risk. Overall, there isn't really any way to prevent ectopic pregnancy from occurring.

Is there an ectopic pregnancy surgery?

There is surgery in case of an ectopic pregnancy that is used to remove the egg before it becomes to large. This procedure is known as laparoscopy, also known as keyhole surgery. This essentially takes out the egg along with the entire fallopian tube - so long as the other tube is healthy.

According to the NHS, removing one fallopian tube isn't going to reduce the odds of you getting pregnant again, and it is the most effective treatment for an ectopic pregnancy.

But if the fallopian tube has already ruptured, an emergency surgical procedure known as a laparotomy will be needed instead to stop the bleeding and, if possible, repair the fallopian tube.

But there isn't just surgery.

Another treatment method is medication, though this can only be done in the earlier stages. 

Doctors use methotrexate for ectopic pregnancy treatments. This is injected into the body and functions by stopping the fetus from growing further. Sometimes, a second dose will also be needed - or even surgery if it doesn't work - and patients will need to use contraception for at least three months and avoid alcohol.

Methotrexate also has side effects such as dizziness, feeling sick, diarrhea and mild stomach pain.

However, there is also always the possibility that the egg will just dissolve into the body by itself, if there are no symptoms or mild symptoms and if the egg is just very small. 

Doctors will still take regular blood tests to check hormone levels to ensure the pregnancy is over and there might still be some bleeding. Stomach pain may also happen, but that should just be treated with Tylenol. 

Both this method and medication still come with the risk, albeit a small one, that the fallopian tube could still rupture though.

Do you get an abortion for ectopic pregnancy?

No. These treatments, even the surgeries, are technically not abortions. 

As noted by Planned Parenthood, an abortion specifically refers to ending a pregnancy inside a uterus. As ectopic pregnancies are not inside the uterus, it cannot be legally, medically or logically be considered an abortion.

However, some US state laws don't see it that way regardless. 

For example, following Texas laws passed in 2021, several pharmacies in the state would no longer fill prescriptions for methotrexate to treat ectopic pregnancies because the drug itself has been banned as an abortion drug, according to media reports.

Back in May, Texas Right to Life legislative director John Seago explained that ectopic pregnancies are not banned under Texas law because they are not considered an abortion and this is all a result of a misunderstanding of the law, NPR reported.

This applies to surgical procedures too, as overall, while laws may not ban ectopic pregnancies, doctors in states around the US are unclear about when and how they're allowed to treat them since the potential legal, professional and financial ramifications of getting it wrong are severe and it is unclear how laws would be interpreted.