A little bleeding and cramping in early pregnancy are not abnormal. Sometimes, these symptoms can indicate an ectopic pregnancy, which does not go to term. Such a pregnancy can be disturbing and make you anxious about your future, but it is rare and occurs in 1 to 2 out of every 100 pregnancies (1). Knowing the signs of this abnormal pregnancy, however, is essential to diagnose and treat it in time.
In this MomJunction post, we tell you what is an ectopic pregnancy, its causes, symptoms, diagnosis, and treatment.
What Is An Ectopic Pregnancy?
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tube or elsewhere in the abdomen. As this pregnancy does not go to term, it is removed by the doctor immediately after diagnosis.
When undetected, the growing tissue destroys the fallopian tube and the other surrounding maternal structures. This eventually leads to internal bleeding and infections, when the pregnancy will naturally end. Ectopic pregnancy can be life-threatening when not diagnosed or treated (2).
Keep reading to know how to identify the condition early on.
Signs And Symptoms Of An Ectopic Pregnancy
Symptoms develop in the early stages of pregnancy and vary from woman to woman. Some women will develop no symptoms until pregnancy ruptures.
During early pregnancy, some women will begin to experience symptoms similar to that of a healthy pregnancy. They may include:
- Missed menstrual period
- Sore breasts
- Upset stomach
- Low back pain
- Vaginal spotting or bleeding
- Abdominal pain or tenderness
- Mild cramping at one side of the pelvic region
Around this phase, it is not easy to understand if it is a normal or ectopic pregnancy. But as the ectopic pregnancy develops, you could experience certain severe symptoms (3):
- Sudden and severe pain in the abdomen, shoulder, neck or pelvis
- Vaginal spotting or bleeding that is light to heavy
- Dizziness, weakness or fainting
- Rectal pressure
You should see your doctor if you know about the pregnancy and are experiencing these symptoms.
[ Read: PCOS And Pregnancy ]
Causes Of An Ectopic Pregnancy
The exact reason for an ectopic pregnancy is unknown. However, the condition is likely to be associated with one or more of the following conditions.
- Scarring or inflammation of the fallopian tubes from a previous infection, medical condition or surgery
- Hormonal reasons
- Birth defects
- Genetic abnormalities
- Medical conditions that influence the shape and condition of the reproductive organs, such as the fallopian tubes (4)
- Intrauterine device
- Multiple sex partners
Note that only your doctor can make the correct diagnosis and give you specific treatment options based on the probable cause and risk factors.
Risk Factors For An Ectopic Pregnancy
Factors that increase the chances of an ectopic pregnancy include:
- Maternal age of 35 years and more
- Previous ectopic pregnancy
- History of fallopian tube, abdominal or pelvic surgeries or multiple abortions
- History of pelvic inflammatory disease (PID)
- History of endometriosis
- Sexually transmitted infections (STIs) such as chlamydia or gonorrhea
- Conception despite intrauterine device (IUD) or tubal ligation
- Conception through fertility drugs and procedures
- Cigarette smoking
- Structural abnormalities in the fallopian tubes (4)
If you think you are at risk, discuss with your doctor or a fertility specialist to minimize the chances of ectopic pregnancies in the future.
How Is Ectopic Pregnancy Diagnosed?
Diagnosing an ectopic pregnancy is tricky. If the symptoms suggest that you are experiencing an ectopic pregnancy, your doctor may (5):
- Test your blood for the pregnancy hormone, human chorionic gonadotropin (hCG)
- Perform an ultrasound to check the uterus and fallopian tube condition
- Conduct a pelvic examination
If an ectopic pregnancy is confirmed based on the above findings, your doctor will suggest the best treatment plan.
[ Read: Tubal Ligation: Benefits, Risks ]
Treating Ectopic Pregnancy
Ectopic pregnancies can be fatal to the pregnant woman. As a fertilized egg cannot survive outside the uterus, it has to be immediately removed for the safety of the mother. Treatment depends on the pregnancy stage, hormonal levels and location of the ectopic pregnancy.
- Medication: Medical management can be tried if hCG is below below 3000iu/l or if there no heart activity or the mass size is <3.5cm According to the American Family Physician (AFP), the common medication prescribed is methotrexate (Rheumatrex).
This drug inhibits the growth of the quickly dividing cells or ectopic mass in this case. It is available in the form of an injection and results in miscarriage-like symptoms including bleeding, cramping, and the passing of the tissue. But the only downside with this treatment is that you will not conceive for several months after taking medicine (6).
- Surgery: The embryo is removed using a procedure called laparoscopy. A small incision is made near the belly button, into which a tiny camera is passed for a better view. The surgeon then removes the pregnancy using surgical tools. Sometimes, the surgery can scar the fallopian tubes, which will then be either repaired (salpingostomy) or removed (salpingectomy) (7). Laparoscopic salpingectomy is the operation of choice if contralateral tube is healthy.
- Emergency surgery: If the condition is causing heavy bleeding, you may need immediate surgery using laparotomy. It involves an abdominal incision and removal of the ectopic mass. Also, the tube may be removed in case it is ruptured.
- Expectant management: 27 to 44% need no treatment if hCG is below 1000iu/l and the patient is asymptomatic. However, strict supervision required.
Are There Any Side Effects Of Surgery?
The possible side effects of surgery for ectopic pregnancy include bleeding, pain, fatigue, and infection. Your doctor will discuss these before the procedure.
Home Care After Surgery
Follow the doctor’s instructions to take care of the incision site at home. The primary goal is to keep it dry and clean as it heals. You should also check the incision for signs of infection regularly:
- Severe and uncontrollable bleeding
- A foul smell at the incision site
- Tender to touch
- Swelling and redness
You may also notice some light spotting and tiny blood clots after the surgery, which lasts for nearly six weeks post the surgery.
Here are a few more self-care measures you should take at home:
- Avoid lifting anything heavy
- Have lots of fluids to treat constipation
- Rest as much as you can
- Avoid sexual intercourse, douching, and using tampons to give some rest to the pelvic area
See your doctor if you feel any pain or that something is not right.
Can You Prevent Ectopic Pregnancy?
No, ectopic pregnancy cannot be prevented entirely, but there are certain ways to reduce the chances of developing it.
- Use condoms during intercourse to avoid the risk of sexually transmitted infections and pelvic inflammatory diseases.
- Avoid sex with multiple partners.
- Quit smoking before you try for pregnancy (8).
Next, we address some common queries for your better understanding of the condition.
Frequently Asked Questions
1. Can a baby survive in an ectopic pregnancy?
No, the baby cannot survive in an ectopic pregnancy as it is formed outside the womb. The tissues outside the uterus cannot provide enough blood supply that the fetus needs to survive.
2. How soon would you know if you have an ectopic pregnancy?
You can detect an ectopic pregnancy as early as four to five weeks. Symptoms to look for include a missed period, positive pregnancy test result, severe abdominal pain, spotting, dizziness or rectal pressure. However, not everyone can detect an ectopic pregnancy through these early signs and may need to get an ultrasound scan.
3. Can a pregnancy test detect an ectopic pregnancy?
Yes, a positive pregnancy test can indicate an ectopic pregnancy, when accompanied by symptoms such as cramps and vaginal bleeding. Even in case of an ectopic pregnancy, your body produces the hCG hormone within ten days of a missed period (9).
4. How long after ectopic pregnancy will I get my period?
You will get your first period within six weeks after the ectopic pregnancy is terminated. It might not be like a normal period, but heavier or lighter and more painful (10).
5. Can you have an ectopic pregnancy without bleeding?
In some cases, ectopic pregnancy is absorbed, and there will be no symptoms of vaginal bleeding. Modern ultrasound scans detect ectopic pregnancies that occur without symptoms such as pain or spotting (11).
6. How painful is an ectopic pregnancy?
Ectopic pregnancy may cause dull and mild to sharp and severe pain (12). You will experience pain in the abdomen, pelvis, and also the neck and shoulder regions.
7. How long does it take to heal from an ectopic pregnancy?
The time for healing from an ectopic pregnancy treatment, whether with medication or surgery, would be four to six weeks (13).
8. Can you remove an ectopic pregnancy without surgery?
Yes, if the fallopian tube has not ruptured and pregnancy is in its initial stages, your doctor would give you an injection to remove the ectopic pregnancy.
9. Can you have an ectopic pregnancy without a positive test?
Yes, there are chances you could have an ectopic pregnancy without a positive result for a home pregnancy test because of the low levels of hCG hormone.
10. Can you get pregnant after you have had an ectopic pregnancy?
Most women who experience an ectopic pregnancy can have normal pregnancies in the future. It does not matter if one of the fallopian tubes was removed since one healthy working tube is enough to help the fertilization. The earlier the ectopic pregnancy is removed, the lesser the damage to the tube and the higher are the chances of conception again (14).
If an infection or sexually transmitted disease were the cause for your ectopic pregnancy, then getting the condition treated improves the chances of conception. But, if the ectopic pregnancy occurs due to tubal ligation or exposure to diethylstilbestrol (DES), the chances of a healthy pregnancy are lesser.
If you’ve had an ectopic pregnancy, check with your doctor before you plan for the next pregnancy. Ensure that you give enough time for yourself to heal emotionally and physically, especially if you’ve had a surgery to treat it. Dealing with an ectopic pregnancy, when you want to have a child, is not easy. If necessary, join a counseling group or talk to a therapist.
Do you have any experiences to share? Let us know in the comment section below.
2. Tian Zhu; Ectopic Pregnancy; The Embryo Project Encyclopedia (2010)
3. Ectopic Pregnancy; UCSB SexInfo (2018)
4. J I Tay et al.; Ectopic pregnancy; BMJ (2000)
5. Heather Murray et al.; Diagnosis and treatment of ectopic pregnancy; CMAJ (2005)
6. Hansa Dhar et al.; Methotrexate Treatment of Ectopic Pregnancy: Experience at Nizwa Hospital with Literature Review; Oman Med J (2011)
7. BS Duggal et al.; Laparoscopic Management of Ectopic Pregnancies; Med J Armed Forces India (2004)
8. Albers K; Comprehensive care in the prevention of ectopic pregnancy and associated negative outcomes; Midwifery Today Int Midwife (2007)
9. Fraser, Marianne and Haldeman-Englert; HCG (Blood); University of Rochester Medical Center
10. Your body after an ectopic pregnancy; The Ectopic Pregnancy Trust
11. Andy Raffles et al.; Mother and Baby Health: The A-Z of Pregnancy, Birth and Beyond; Page 203
12. Constance J. Creech; Ectopic Pregnancy; JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS
13. Treatment – Ectopic pregnancy; NHS
14. Chanda Karki et al.; Ectopic Pregnancy and its Effect on Future Fertility; South Asian Federation of Obstetrics and Gynecology (2009)
- Implantation Symptoms: What Are The Early Signs?
- What Is Viable/ Non-Viable Pregnancy?
- Cryptic Pregnancy: Causes, Signs & Prevention
- Pregnancy After Tubal Ligation