Ectopic Pregnancy

Written by: Dr. Amy Beckley, PhD, Founder and Inventor of the Proov test — the first and only FDA-cleared test to confirm successful ovulation at home.

Written on 12/22/20

Trigger warning: This blog discusses early pregnancy loss.

What is an ectopic pregnancy?

An ectopic pregnancy, also called an extrauterine pregnancy, occurs when an embryo attaches and grows outside the uterus. They are pretty rare, occurring in about 1 in 50 pregnancies in the United States, yet they can be deadly and it is extremely important to raise awareness and make sure you know how to recognize the signs and symptoms.

In 90% of ectopic pregnancy cases the embryo lodges in the fallopian tubes. As the pregnancy progresses it may cause the rupture of the tube, which in turn may cause internal bleeding which is a life threatening emergency.

An ectopic pregnancy can’t be saved and has to be removed either by using medication (if it hasn’t ruptured) or through surgery (if the tube burst). While it is sometimes referred to as a tubal pregnancy, an ectopic pregnancy may also implant in the cervix, on one of the ovaries, or anywhere else in the abdominal cavity.

An ectopic pregnancy, also called an extrauterine pregnancy, occurs when an embryo attaches and grows outside the uterus.

What causes an ectopic pregnancy?

We don’t always know what causes an ectopic pregnancy but we do know some women are more at risk than others.

The main causes of ectopic pregnancy are:

• Pelvic inflammatory disease, which if left untreated may lead to inflammation and narrowing of the tubes. That is why yearly screening for chlamydia infection is essential for women who are sexually active and at risk for STDs.
• Previous fallopian tube surgery, especially an unsuccessful tubal ligation procedure.
• In-vitro fertilization (IVF), especially with tubal factor infertility and transfer of more than 3 embryos, increases the risk of ectopic pregnancies.
• Getting pregnant while using an IUD.

Other factors that increase the risk of getting an ectopic pregnancy are:

• Having previously had an extrauterine pregnancy in the past (chances of experiencing one again are around 10% higher than for the rest of the population).
• Smoking
• Older maternal age (specifically older than 35 years)

How do I know if I’ve had an ectopic pregnancy?

An ectopic pregnancy isn’t viable. An embryo cannot survive outside of the uterus because the tissues outside the uterus aren’t able to provide the blood supply and necessary support for a fetus to grow and survive.

There are several possible outcomes:

• Just like any normal uterine pregnancy, an ectopic pregnancy may end before you even find out you were pregnant. You may experience some bleeding and some pain. You also may mistake it for a very early miscarriage or even for your period. If that is the case, there is nothing you need to do about it further.
• Your doctor may begin to suspect an ectopic pregnancy either because your progesterone levels are low during the luteal phase, your beta human chorionic gonadotropin (hCG) levels aren’t doubling properly, or both, although the pregnancy may still be too small to be seen. In this case you will probably be closely monitored until the pregnancy becomes visible, in which case your doctor will determine the best route for treatment.
• In the very unfortunate case an ectopic pregnancy is missed or misdiagnosed, it may grow until it eventually causes your tube to rupture, requiring emergency surgery.

An embryo cannot survive outside of the uterus because the tissues outside the uterus aren’t able to provide the blood supply and necessary support for a fetus to grow and survive.

What are the signs and symptoms of an ectopic pregnancy?

An ectopic pregnancy doesn’t always cause any symptoms and is sometimes discovered at a routine pregnancy scan. But many women may experience common pregnancy symptoms like a missed period, nausea, sore breasts, or a positive pregnancy test.

Yet there are some warning signs that might appear weeks before any potential symptoms and that might raise suspicion about an ectopic pregnancy. These signs should encourage further medical investigation:

• Low progesterone levels during the luteal phase
• Low or slow rising beta hCG levels

Typical symptoms of an ectopic pregnancy usually appear between 6 and 8 weeks of gestation, under the form of:

• Vaginal bleeding
• Abdominal or pelvic pain that may be more intense when you are moving or stretching
• Discomfort when using the toilet
• Pain in the tip of the shoulder in case the pregnancy ruptured and you are having internal bleeding

Sometimes, a misdiagnosed tubal pregnancy may grow large enough to make the fallopian tube burst. When this happens the symptoms are quite strong and pretty hard to miss:

• A sudden, violent pain on one side of your lower abdomen
• Dizziness
• Severe nausea and vomiting
• Severe diarrhea
• Signs of shock: pallor, tachycardia, fainting

If you experience this kind of symptoms — especially if you missed your period but even in the absence of a positive pregnancy test — you should call an ambulance or go to the nearest emergency room for immediate assessment.

Typical symptoms of an ectopic pregnancy usually appear between 6 and 10 weeks of gestation.

How do I prevent an ectopic pregnancy?

While ectopic pregnancies cannot be prevented, there are certain things you can make sure of in order to try and minimize the risk, including:

• Preventing sexually transmitted diseases that may lead to pelvic inflammatory disease and eventually to scarring of the tubes, by reducing the number of sexual partners and using condoms.
• Giving up smoking before trying to conceive

Pregnancy loss of any kind is a devastating experience. The good news is that with today’s advancement in medicine and ultrasound technology, most ectopic pregnancies are detected in their early stages and most women experiencing them do not need surgery.

Also, we are very lucky to have access to modern methods of cycle monitoring at home. We can use ovulation strips to check our LH surge and predict when ovulation is going to occur. We can us PdG tests to monitor levels during the luteal phase. PdG is a progesterone metabolite. Low PdG levels or ovulatory disorders can make it more difficult to successfully conceive.

Knowledge is power and getting educated about the risks, signs, and symptoms of an ectopic pregnancy may help you detect a potential issue in its early stages.