An ectopic pregnancy develops when an embryo grows outside or on a scarred part of the uterus. Ectopic pregnancies can cause pain, bleeding, nausea, and vomiting.

Ectopic pregnancies occur at a rate of 1%-2% in the general population and 2%-5% among individuals who have used assisted reproductive technologies. Fewer than 10% of ectopic pregnancies are estimated to involve implantation outside the fallopian tube.

There are three areas of the fallopian tubes where ectopic pregnancies most commonly occur: the ampulla, the infundibulum, and the isthmus.

An ectopic pregnancy typically develops when an egg cannot make its normal journey down the fallopian tube and into the uterus. If you have had any of the following, you may be at a higher risk of developing an ectopic pregnancy: 

• History of ectopic pregnancy
• History of pelvic inflammatory disease (PID)
• Past surgery on the uterus, ovaries, and fallopian tubes, or the pelvic region
• History of infertility

Early signs of an ectopic pregnancy can be hard to distinguish from those of a normal pregnancy. Additional symptoms, however, are possible during an ectopic pregnancy and may include:

• Vaginal bleeding;
• Lower back, hip, and stomach pain;
• Weakness or dizziness.

The pain and bleeding from a ruptured fallopian tube could be severe enough to trigger further symptoms. Some examples of these are:

• Fainting;
• Hypotension;
• Shoulder pain.
• Rectal pressure.

Most importantly, pain in the lower abdomen is a common symptom of a ruptured fallopian tube. Meanwhile, for women who are pregnant but who have previously had a tubal ligation or an IUD but became pregnant, in such cases, ectopic pregnancies seem to occur more frequently.

When an ectopic pregnancy is suspected, transvaginal ultrasound imaging is essential. With ultrasound, serum hCG levels are also required to make a definitive diagnosis. Thus, ultrasound imaging that reveals a fetal heartbeat outside the uterine cavity is the best method for diagnosing an ectopic pregnancy. However, because not all ectopic pregnancies result in the development of a fetal heartbeat, the absence of a detectable heartbeat may be deceptive.

In rare cases, such as when big uterine fibroids are causing obstruction, MRI imaging can be helpful. However, more studies need to be done to assess its usefulness. 

The majority of ectopic pregnancies are discovered early in the pregnancy. The bulk of incidents occur within the first three months. By the eighth week, it is frequently detected.

Treatment

There are several techniques to treat an ectopic pregnancy. Methotrexate is a drug administered to prevent the pregnancy from progressing further. This procedure will cause the pregnancy to end. Compared to surgery, this method is less intrusive, but it still requires regular monitoring of serum hCG levels.

Extreme circumstances frequently call for surgeries, such as when the fallopian tube has ruptured or has already ruptured. This operation is, in fact, a matter of life and death and is usually done through laparoscopic surgery. If it is impossible to retrieve the egg from the fallopian tube, the surgeon may opt to remove the entire tube.

Ectopic pregnancy is not preventable; however, some of the risks can be controlled. Quitting smoking, eating right, and protecting oneself from sexually transmitted diseases (STD) are ways to control the risk. Before trying to get pregnant, it’s a good idea to discuss any potential risks with a doctor.

Women planning for future pregnancies should discuss this with their doctor after ectopic pregnancy treatment. Pregnancy can occur soon after therapy, but waiting three months is recommended. The fallopian tube can heal by waiting, and the likelihood of another ectopic pregnancy is reduced.

References

Mummert T, Gnugnoli DM. Ectopic Pregnancy. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539860/

Cleveland Clinic (2022). Ectopic Pregnancy. Retrieved November 4, 2022, from https://my.clevelandclinic.org/health/diseases/9687-ectopic-pregnancy#symptoms-and-causes