Ectopic pregnancy is a pregnancy that develops outside the uterine cavity. It occurs when the egg settles in a fallopian tube (most often), or more rarely on an ovary, in the abdominal cavity, or on the cervix.

Normally, the egg is fertilized by a sperm in the fallopian tube, then it travels into the uterus to implant on the uterine wall and begins its development. In the case of an ectopic pregnancy, the fertilized egg will get stuck in the tube and start to develop in the wrong place.

An ectopic pregnancy cannot be brought to term and it is essential to perform emergency intervention as soon as it is detected. It is quite rare in the United States, with less than 200,000 cases, but not negligible. According to the American Pregnancy Association, 1 in 50 pregnancies is ectopic.

Causes of ectopic pregnancy

96% of ectopic pregnancies develop in one of the tubes. This is called a tubal pregnancy and can be caused by several things:

• an abnormality of the fallopian tubes,
• inflammation
• physical trauma
• hormonal imbalance

Sometimes it is impossible to find the underlying cause for the development of ectopic pregnancy.

Who is affected by ectopic pregnancy? What are the risk factors?

In a large number of cases, ectopic pregnancy seems to occur for no reason. However, doctors note that the risks increase in the following cases:

• Presence of pelvic inflammation syndrome, which is usually caused by a sexually transmitted infection (chlamydia, gonorrhea).
• Wearing an IUD: when there is fertilization despite this method of contraception, the pregnancy can be ectopic.
• The woman’s age (over 35).
• Previous abdominal surgery (appendectomy, tubal ligation).
• Treatments for fertility (medically assisted procreation).
• Taking certain contraceptives (Depo-Provera).
• Malformation of the fallopian tubes.
• Past ectopic pregnancies.
• Smoking.

The main symptoms of ectopic pregnancy

In the early stages of pregnancy, some women have no symptoms at all, not even knowing they are pregnant. They will generally be alerted by:

• light vaginal bleeding;
• abdominal cramps.
• It is only by consulting their doctor that they will be able to detect the presence of an ectopic pregnancy.

When the ectopic pregnancy is a little more advanced, it will have the same symptoms as an ordinary pregnancy:

• absence of menstruation,
• breast tenderness,
• tiredness,
• nausea,
• a positive pregnancy test

It is usually 3 to 6 weeks after fertilization that vaginal bleeding and abdominal cramps of varying intensity occur, depending on the stage of development of the embryo.

Women with an ectopic pregnancy can also have:

• a sharp one-sided pain in the lower abdomen;
• pain in the shoulder.

6 to 8 weeks after the last period, there is often a rupture of one of the fallopian tubes, which leads to:

• severe abdominal pain,
• a drop in blood pressure due to internal bleeding,
• a state of shock: excessive sweating, pallor, fainting.

Diagnosis of ectopic pregnancy

Only a doctor can diagnose an ectopic pregnancy. Usually, a pelvic exam, ultrasound, and blood tests will be conducted. When drugstore tests and blood tests show the presence of the pregnancy hormone, but the embryo is not visible in the uterine cavity, the pregnancy is ectopic.

It is then mandatory to remove the embryo and placenta from the tube (or any other area where the egg is implanted.)

Possible risk of complications

The longer the ectopic pregnancy lasts, the greater the risks. When the fallopian tube ruptures, there can be severe hemorrhage that endangers the life of the woman. In Western countries, the risk of maternal death during the first trimester of pregnancy is mainly related to an ectopic pregnancy.

In addition, in some cases, the only possible treatment is the removal of the affected tube, which can cause permanent infertility (in case the 2nd fallopian tube is already affected).

Treatment of ectopic pregnancy

The only treatment for ectopic pregnancy is to remove the egg. Depending on the stage of pregnancy, there are two main ways:

• An injection of methodextrate: a medicine that stops cells from growing and destroys existing ones.
• Surgical treatment: either the tube is cut to remove all the residue, or the tube is completely removed or it is cauterized, that is to say, it is burned, in whole or in part. In these last two cases, the proboscis is no longer functional thereafter.

Prevention of ectopic pregnancy

There is no sure way to prevent an ectopic pregnancy. On the other hand, certain measures can reduce the risks:

• Safe sex to avoid sexually transmitted infections (STIs).
• Treatment of existing STIs.
• Cessation of smoking

In conclusion

Ectopic pregnancy is a very serious event, with sometimes fatal consequences. If you have symptoms of normal pregnancy (lack of periods, breast tenderness, nausea) and mild vaginal bleeding accompanied by abdominal cramps, do not hesitate to see your doctor very soon.

Early diagnosis allows relatively easy treatment with few sequelae.
However, if you also have severe abdominal pain and heavy vaginal bleeding, tube rupture is imminent (if you haven’t already) and you should go to a hospital emergency room immediately.