An ectopic pregnancy is when a fertilized egg implants and develops outside of the normal location in the uterus. This could be in a fallopian tube (97 percent of ectopic pregnancies are found here), on an ovary, on the cervix, or in even stranger locations like the abdomen. An estimated 2 percent of all pregnancies are ectopic, and they can be life-threatening if not recognized and treated appropriately.
Certain risk factors make having an ectopic pregnancy more likely. These include a history of pelvic infection or tubal surgery (including a tubal ligation), as they alter the inside of the fallopian tube. This makes it harder for an egg to travel to its normal implantation site in the uterus. Having had one ectopic pregnancy also puts you at increased risk for future ectopics. In fact, that recurrence rate is about 33 percent. Smoking is also an important risk factor—yet another reason to quit!
Symptoms of an ectopic pregnancy include abdominal pain and bleeding, usually (though not always) in the first trimester. If your doctor is concerned about an ectopic pregnancy, he or she will order an ultrasound to see where the pregnancy is located. However, it can be difficult to see a very early pregnancy, so they may also want to follow your pregnancy hormone levels. This is a blood test, and you may need it checked every few days to see if your levels are increasing normally.
If a diagnosis of an ectopic pregnancy has been made, your doctor will either recommend medical or surgical treatment (expectant management, where nothing is done, is usually only offered if you are very stable and your pregnancy hormone levels are very low).
If your bleeding is very heavy and you are having other concerning symptoms (such as severe pain or passing out), surgery will be the likely route. This procedure is usually done laparoscopically and involves removing the ectopic pregnancy, with or without the fallopian tube (if it is located here). Many women are able to go home soon after the procedure or the next day. Unfortunately, an ectopic pregnancy is incompatible with a successful pregnancy.
Medical treatment involves receiving an injection of a medicine called methotrexate. This is a chemotherapeutic agent. It inhibits the growth of rapidly dividing tissues, including those of a developing pregnancy. If you receive this medication, your doctor will review warning signs of when to call as well as a detailed follow-up plan. Occasionally women who first undergo medical management still end up needing surgery, so it is important to keep this in mind.
As mentioned earlier, a history of an ectopic pregnancy does increase your future risk to about 33 percent. There is no difference as to the effect on future pregnancies when it comes to deciding between medical or surgical treatment. If you’ve had an ectopic pregnancy before, be sure to let your doctor or midwife know so they can follow your next pregnancy more closely.
Reviewed by Dr. Jen Lincoln, April 2020
- An ectopic pregnancy is a pregnancy outside of the uterus.
- Ectopic pregnancies occur in about 2 percent of all pregnancies.
- Medical or surgical treatments are available, and they each have their own risks and benefits.
- Having an ectopic pregnancy greatly increases your risk of recurrent ectopics.