The truth about ectopic pregnancy care
October 22, 2019
Women’s health has always been a fiercely debated topic, socially and politically. The latest debate is whether treatment is necessary for ectopic pregnancy, a condition in which a fertilized egg implants in a woman’s fallopian tube or ovary instead of her uterus.
Scientifically, there is no debate – treatment is the best option. An embryo implanted outside the uterus has virtually no chance of surviving to birth. In a few rare instances, we have seen embryos grow for 12 to 13 weeks before they die due to insufficient hormone and nutrition supply. But when left growing that long, the embryo becomes large enough to rupture the patient’s fallopian tube, causing abdominal hemorrhage and even death.
Still, some people argue that intervening is immoral, comparing it to termination of a viable pregnancy. An opinion article published recently on The Federalist spread misperceptions about ectopic pregnancy management and potentially stigmatized women who seek care. The author, who has no medical training, suggested ectopic pregnancy care is unnecessary – a conclusion she based on “data” from sources such as an outdated medical opinion from the early 1980s and a political/religious magazine article.
The piece was scientifically refuted in a Vox article two days later, including a statement by the American Association of Pro-Life Obstetricians and Gynecologists that ectopic pregnancy “cannot result in the survival of a baby and entails a very substantial risk of maternal death or disability."
A week later, The Federalist published a public apology article, in which the author admitted to misinterpreting scientific data, using incorrect medical terminology, and pushing a biased agenda. The entire episode highlights the dangers of spreading false health information and potentially exposing women to emotional and physical harm.
Emotional concerns with ectopic pregnancy
Ectopic pregnancy treatment is not the same as abortion. The medical definition of “abortion” is removal of an embryo and placenta from the uterus. This includes termination of unwanted pregnancy as well as otherwise normal pregnancy in which the fetus’ or mother’s life is in danger. Note the phrase “from the uterus” – the only place an embryo can develop into a baby. Logically, treatment cannot be generalized as “abortion,” particularly because many women with ectopic pregnancies planned to conceive and wanted to carry their pregnancies to term.
It is not your fault. Certain factors are associated with an increased risk of ectopic pregnancy, including a history of smoking, in vitro fertilization, assisted reproductive technology, and prior pelvic or abdominal surgery. However, the American College of Obstetricians and Gynecologists states that approximately half of patients have no risk factors. And unfortunately, having one ectopic pregnancy increases the risk of having another.
It’s common for patients to feel guilty after any type of pregnancy loss. Patients tell us they feel as if they could have done something to prevent it. But know this: You did nothing wrong to cause the ectopic pregnancy, and there is nothing you or a doctor could have done to turn it into a healthy pregnancy.
Related reading: How to be a good friend to someone who’s suffered pregnancy loss
In virtually all ectopic pregnancies, the embryo will not survive past the first trimester. In more than 90% of ectopic pregnancies, the egg implants in one of the mother’s fallopian tubes. There is currently no way to transplant such an embryo into the uterus, even with today’s technology.
In the rarest of ectopic pregnancy cases, the embryo is implanted somewhere in the abdomen rather than the fallopian tubes and is situated near the liver or other organs where blood supply is rich. Even then, chances of survival are infinitesimal. Such cases are virtually nonexistent because early ultrasound is the standard of care in the U.S. Patients who have early pregnancy ultrasounds can be identified early to avoid the potential catastrophic bleeding of an abdominal ectopic pregnancy.
The physical risks of untreated ectopic pregnancy
Though ectopic pregnancies comprise just 1% to 2% of all pregnancies, the condition is the leading cause of pregnancy-related maternal death in the first trimester, usually due to lack of medical intervention. In the U.S., 76 deaths were attributed to ectopic pregnancy between 1998 and 2007.
Treatment is recommended. If the fallopian tube ruptures, the patient is more than likely going to lose the tube. Some patients might also lose the ovary on that side. If a rupture occurs, there will be a risk for abdominal hemorrhage – severe bleeding that can be fatal without immediate medical attention.
It is possible for an early ectopic pregnancy to end in miscarriage on its own. However, in most cases it does not, and medical intervention is needed. To treat ectopic pregnancy, the doctor will recommend either a surgical procedure or a medication called methotrexate. In rare occasions, the drug can have serious side effects, such as liver or skin reactions, so it is important to discuss the most appropriate treatment with your doctor.
Symptoms of ectopic pregnancy
Ectopic pregnancy will register a positive home pregnancy test. It won’t be clear whether the pregnancy has a chance to be viable until one of your first trimester prenatal appointments when an ultrasound will help determine where the egg is implanted.
The initial signs of ectopic pregnancy are similar to symptoms sometimes found in healthy early pregnancies:
- Light vaginal bleeding
- Mild abdominal cramping
- Missed period
- Tender breasts
Patients sometimes shrug off these symptoms, having experienced them in a previous successful pregnancy. Not every episode of cramping or light spotting indicates ectopic pregnancy. Others might wait to be examined at their first prenatal appointment.
However, if an ectopic pregnancy develops past a few weeks, the patient will likely have more severe symptoms such as sharp abdominal or pelvic pain and dizziness.
If you have any ectopic pregnancy symptoms, or any symptoms that make you concerned, call your doctor. Your health and safety is our No. 1 priority, and we will give you the facts and options you need to make informed decisions about your care.