Ectopic pregnancy: How to recognize the symptoms? What to expect?

How soon would you know if you have an ectopic pregnancy? What are the symptoms? Is it possible to carry an ectopic pregnancy to term? Is it possible to conceive after an ectopic pregnancy? Now, let's explore the causes of ectopic pregnancy, how to spot one, and what to do if you become pregnant unexpectedly!

What is an ectopic pregnancy?

An ectopic pregnancy occurs when the embryo implants outside of the uterus. Ectopic pregnancies most commonly occur in the fallopian tubes (accounting for up to 95% of cases), following with ovaries, abdominal cavity, or cervix.

An ectopic pregnancy can occur in approximately one pregnant woman out of every 100, and for those who have already experienced one, the chance of experiencing another one during a subsequent pregnancy increases tenfold.
 

What are the symptoms and signs of an ectopic pregnancy?

An ectopic pregnancy can cause nausea, vomiting, shoulder or neck pain, as well as pelvic and abdominal pain. It should not be taken lightly because the most serious consequence could be a fallopian tube rupture, which could cause life-threatening bleeding and excruciating lower abdominal pain.
 

Ectopic pregnancy symptoms can be categorized as chronic and acute (sudden):

Chronic Ectopic Pregnancy

The symptoms are less noticeable. Patients with chronic ectopic pregnancies often have lower β-hCG levels, and their symptoms are generally less pronounced. Diagnosis may require ultrasound and blood tests, and sometimes it may take 1-2 months into the pregnancy to confirm the ectopic pregnancy.
 

Acute Ectopic Pregnancy

Acute ectopic pregnancies involve bleeding and pain. Patients typically experience significant bleeding and intense pain that is not relieved by pain medication. This condition can even lead to shock, and it requires immediate emergency medical attention.

Ectopic pregnancy symptoms can vary from person to person, but the most common signs include vaginal bleeding and abdominal pain, which should be closely monitored in early pregnancy. If there is a risk of ectopic pregnancy, symptoms such as sudden abdominal pain, shoulder pain, general weakness, and dizziness may indicate a ruptured fallopian tube, and immediate medical attention should be sought.
 

What causes an ectopic pregnancy?

The most common reasons for ectopic pregnancy include abnormal fallopian tube function due to fallopian tube disease or congenital malformation of the fallopian tubes.

Structural issues or inflammation of the fallopian tubes can slow down or block the movement of the fertilized egg. If the fertilized egg fails to reach the uterine cavity by days 5-9 of development, it may directly implant in the lining of the fallopian tube, resulting in an ectopic pregnancy.

The following are common causes of ectopic pregnancy:

• You have adhesions or infections due to fallopian tube surgery.
• You have experienced a previous ectopic pregnancy.
• You have experienced multiple miscarriages or induced abortions.
• You are born with an abnormal fallopian tube structure or development.
• Failure of contraception after using an intrauterine device.

 

Who is at high risk for ectopic pregnancy?

Main risk factors for ectopic pregnancy include:

• A previous ectopic pregnancy
• A history of pelvic inflammatory disease or surgery
• Prior fallopian tube surgery
• Becoming pregnant while using birth control pills or an intrauterine device
• Smoking habits
• Endometriosis

 

How to diagnose an ectopic pregnancy?

A gestational sac should be observed through transvaginal ultrasound within the first 8 weeks of pregnancy. Blood tests are used in conjunction with ultrasound to diagnose an ectopic pregnancy if it cannot be seen during prenatal check. An ectopic pregnancy is highly suspected if the gestational sac is still invisible despite β-hCG levels exceeding 2000–4,000. At this stage, the uterine cavity's surrounding tissues will be checked for indications of a gestational sac and the levels of β-hCG will be tracked.
 

How is ectopic pregnancy treated?

The course of treatment for an ectopic pregnancy is determined by a number of factors, including the size of the embryo, the presence of a heartbeat, the gestational age, and the presence of internal bleeding. In order to protect the pregnant woman's health from future harm, ectopic pregnancy treatment usually entails terminating the pregnancy.
 

Ectopic Pregnancy Medication Treatment

Methotrexate (MTX) medication can be used to halt the fetal growth if no fetal heartbeat is detected in the early stages. A reduction in β-hCG levels requires regular blood tests in addition to ongoing monitoring.

Drinking alcohol should be avoided while taking MTX medication in order to protect the liver. It is also advised to use contraception for a minimum of three months following MTX treatment in order to avoid any potential negative effects on the health of a subsequent pregnancy during this time.
 

Ectopic Pregnancy Surgical Treatment

Laparoscopic surgery is required to treat the ectopic pregnancy if there is internal bleeding in the pelvis and there is a fetal heartbeat.

An abdominal incision is made while the patient is under anesthesia for ectopic pregnancy surgery. After that, the surgeon opens the abdominal cavity with a laparoscope. Prior to the procedure, it is advisable to discuss future pregnancy plans with the attending physician, as in some cases, the affected fallopian tube may be removed during the procedure.

Patients who have had surgery or medication to treat an ectopic pregnancy may have fatigue and abdominal pain for a few weeks after the procedure.
   

More detailed questions about ectopic pregnancy

1. Can you carry the ectopic pregnancy to full term?

Ectopic pregnancy cannot be carried to term because the embryo is located outside the uterus. This not only prevents the proper development of the fetus but also poses a serious risk to the mother's life. Therefore, terminating the pregnancy is necessary.
 

2. Can an ectopic pregnancy affect future pregnancies?

After experiencing an ectopic pregnancy, there is still a 60% chance of a successful pregnancy in the future, but there is also a 10-fold increased risk of another ectopic pregnancy.

For women who have had both fallopian tubes removed, the pregnancy success rate through in vitro fertilization is around 30% to 40% or higher. For those who have undergone medication treatment, retained one fallopian tube, or have only one remaining fallopian tube, 66% of patients achieve a successful pregnancy within a year, and 81% achieve a successful pregnancy within two years.
 

3. Does the color of the pregnancy test strip matter in an ectopic pregnancy?

Ectopic pregnancy is still a form of pregnancy, and the color that appears on a pregnancy test strip does not differ from a normal pregnancy.
 

4. How does ectopic pregnancy affect my period?

Ectopic pregnancy is considered a form of pregnancy, so a missed period is normal. Additionally, since ectopic pregnancy may involve bleeding, it can be mistaken for a menstrual period.
 

5. How long should I wait before trying to conceive again after an ectopic pregnancy?

After undergoing ectopic pregnancy surgery, it is recommended to wait at least two menstrual cycles before starting to try to conceive again. If MTX medication treatment was used, it is advisable to wait for at least three months to ensure that the medication does not affect the health of the next pregnancy.
 

6. How soon would I know if I had an ectopic pregnancy?

Ectopic pregnancy symptoms typically manifest around 6–8 weeks into the pregnancy. If you experience discomfort, it is advisable to seek medical attention for an ectopic pregnancy assessment to confirm the embryo's condition and the presence of an ectopic pregnancy.
 

7. Can I still have a baby after an ectopic pregnancy?

Ectopic pregnancy treatment may affect ovarian function, but if the other ovary is healthy, there is still a chance of a natural pregnancy. However, seeking advice from a specialized infertility clinic for proactive preconception guidance is recommended.
 

Research Sharing: Clinical Approaches to Ectopic Pregnancy

▲[EN SUB]Clinical Approaches to Ectopic Pregnancy
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Women who have experienced ectopic pregnancy are at a higher risk of having another ectopic pregnancy in subsequent pregnancies. Using embryo transfer protocols is advised to reduce the incidence of ectopic pregnancies and the resulting incapacity to carry a pregnancy to term. This method allows for precise implantation of the embryo into the uterus and combines it with uterine relaxants to reduce uterine contractions, thus ensuring a smoother and more scientific approach to pregnancy and childbirth.
 

International Research: Fresh Embryos Have a Higher Risk of Ectopic Pregnancy Compared to Frozen Embryos

An international research paper claims that the use of ovulation-inducing drugs by the patient before implantation can result in elevated estrogen levels, which may cause abnormal contractions in the uterus during the implantation of fresh embryos. This may increase the chance of an ectopic pregnancy by pushing the embryo into the uterine corner.

In contrast, when frozen embryos are implanted, there is a lower likelihood of abnormal uterine contractions since ovulation-inducing drugs were not used in the lead-up to implantation. Consequently, the risk of ectopic pregnancy is similar to that of natural pregnancies.

Ectopic pregnancy is an unfortunate event that no expectant mother wishes to experience. Although ectopic pregnancies are not entirely preventable, we can lower the risk by stopping smoking and using condoms to avoid STDs. Furthermore, it's critical to follow medical advice regarding routine prenatal checkups and to give particular attention to physical symptoms in the early stages of pregnancy.
   

Reference

1. American College of Obstetricians and Gynecologists：Ectopic Pregnancy
2. Londra, L., Moreau, C., Strobino, D., Garcia, J., Zacur, H., & Zhao, Y. (2015). Ectopic pregnancy after in vitro fertilization: differences between fresh and frozen-thawed cycles. Fertility and sterility, 104(1), 110-118.