Danger Level: High

What is it?

Ectopic pregnancy is a pregnancy in which the embryo grows in places other than the uterus.

Who gets it?

There are a few risk factors which increase a woman’s risk of having an ectopic pregnancy -

1. Problems in the fallopian tubes – In a normal pregnancy, an egg gets fertilized by a sperm, after which the fertilized egg travels through the fallopian tubes to reach the uterus. When the fallopian tubes are damaged or abnormal there can be problems with this process.
   Things that can cause such problems in the fallopian tubes include previous infection or surgery, tumors, or rarely, malformations which were present since birth.
2. Previous ectopic pregnancy – Once a woman has an ectopic pregnancy, her chances of having another one are higher.
3. Exposure to DES (diethylstilbestrol) – DES is a drug that was given to women since 1938 (to prevent miscarriages, among other things), until 1971, when it was found to cause a vaginal and cervical cancer in the daughters of women who took the pill. Daughters of women who took the pill also have greater chances of having anomalies in their reproductive tracts, infertility and poor pregnancy outcomes.

   One of the anomalies in the reproductive tracts which can be caused by DES include problems in the fallopian tubes, which can cause an ectopic pregnancy.

4. Genital infections – Infections in the past with the germs gonorrhea or chlamydia can increase the risk of having a tubal pregnancy.
5. Smoking
6. IVF – Women who use IVF (in-vitro fertilization – a fertility treatment in which the woman’s egg is fertilized in the lab, outside the body, and then placed in her uterus) have a higher risk of having an ectopic pregnancy.
7. Intrauterine contraceptive devices (IUD) – Although they’re supposed to prevent pregnancy, if pregnancy does occur while using them, there’s a higher chance of it being ectopic.
8. After tubal sterilization – Tubal sterilization is a procedure in which the fallopian tubes are cut, tied, or burned, in order to prevent further pregnancies. Rarely, the procedure fails and pregnancy still occurs. In such pregnancies, there’s a higher risk of having an ectopic pregnancy.

Ectopic pregnancy occurs in about 2% of all pregnancies.

What causes it?

Because of any of the reasons above, the egg in an ectopic pregnancy doesn’t implant itself in the wall of the uterus, like in a normal pregnancy. Instead, it attaches to some other surface. 98% of cases occur in the fallopian tubes (this is why the condition is often called “tubal pregnancy”).

Other places in which it can occur are the cervix, the ovary or the joining place of the uterus and the fallopian tube. In even rarer cases, the egg can attach to the abdominal wall, in which case the fetus will grow inside the abdomen.

Ectopic pregnancy. You can see the baby growing outside the uterus (the black area in the center).

How does it feel?

Symptoms of an ectopic pregnancy usually occur in the beginning of pregnancy, around 5-8 weeks after the last period. They include -

1. Abdominal pain – Usually in the lower abdomen, on the right or left.
2. A missed period
3. Vaginal bleeding
4. Symptoms of normal pregnancy (Such as breast tenderness, nausea, etc.)

The dangerous thing about an ectopic pregnancy is that an embryo which wasn’t implanted in the uterus can’t develop normally. This can cause rupture of the organ in which it implanted, which can lead to internal bleeding, shock and even death.

Unfortunately, in over 50% of women, the typical symptoms above don’t occur and they know about the ectopic pregnancy only when the fallopian tube ruptures, in which case the pain and the bleeding will be greater.

This video sums up the symptoms:

How is it discovered?

A few tests can be done to discover an ectopic pregnancy -

1. Ultrasound – It’s done through the vagina and will show if the pregnancy is in the uterus or not.
2. Blood test – The level of hCG are checked. hCG is a substance which is secreted by the embryo. It’s levels are different in an ectopic pregnancy than those that are supposed to be in a normal pregnancy.

How is it treated?

Ectopic pregnancies can be treated either with a drug or by surgery:

1. Drugs – A drug called methotrexate is given, which stops the growth of the embryo.
2. Surgery – Sometimes a surgery is preferred over methotrexate (for example, when the tube ruptures, or when the woman can’t be monitored appropriately during the drug treatment). The ectopic pregnancy is taken out in the surgery.

What happens after treatment?

If the drug was given, the women stays in the hospital and is monitored to see that the levels of hCG are dropping. In the appropriate situation, methotrexate is successful in up to 98% of cases. When it’s not successful, the tubes can rupture, which is why monitoring is so important.

The bottom line – How do I prevent it?

There are a few things you can do to lower your chances of having an ectopic pregnancy:

1. Stop smoking – We previously featured an article about the benefits and the how of stopping smoking.
2. Use safe sex practices – Such as using a condom. It will lower your risk of getting an infection, which, in turn, will lower your chances of having an ectopic pregnancy. Also limiting the number of sexual partners may help.
3. If you do get an STD (sexually transmitted disease), treat it early! 

Know of anyone who has had an ectopic pregnancy, or experienced it yourself? Share your story in the comments.

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