Probably the most dangerous cause for bleeding during the 1st trimester is an ectopic pregnancy. Ectopic pregnancy occurs when your fertilized egg implants somewhere outside the uterus--usually the fallopian tube--and begins growing. ("Ectopic" means "out of place.") Typically this happens if your fallopian tube is blocked by scar tissue or has an abnormality. Eventually the abnormal pregnancy will grow and could cause the tube to rupture; if this occurs, severe abdominal pain and bleeding will result. Most ectopic pregnancies are diagnosed in time to prevent this, but in the United States the condition still causes about 50 deaths a year.
One out of every 100 pregnancies is ectopic. How do you know if you have an ectopic pregnancy? In addition to vaginal spotting or bleeding, you might suffer from abdominal or pelvic pain and vomiting. You may also have an odd pain in the tip of your shoulder, caused by internal bleeding that irritates nerves that travel to your shoulders. If you have any of these symptoms, call your health care provider immediately. You're much more likely to save your fallopian tube--and perhaps your own life--if you treat an ectopic pregnancy early.
At the doctor's office or emergency room, alert your provider to any risk factors you may have for an ectopic pregnancy. These include a prior tubal ligation, a previous ectopic pregnancy, getting pregnant with an intrauterine device (IUD) in place, having a mother who took DES (diethylstilbestrol) while pregnant with you, or infertility treatments. (Infertility is often caused by damaged tubes, so there's a higher chance that you'll have an ectopic pregnancy if you've been infertile.) Other risk factors are pelvic infections and surgeries, such as the removal of an ovarian cyst.
In diagnosing an ectopic pregnancy, the doctor will most likely administer a blood test to check the level of the pregnancy hormone hCG. You may also have a vaginal exam and an ultrasound to check for an enlarged fallopian tube and the presence of an abnormal pregnancy. If you're not in pain, you may be monitored for several days with hormone tests and ultrasounds to confirm the diagnosis.
If diagnosed early, an ectopic pregnancy can be treated without surgery. You may be given methotrexate, a drug that will remove the abnormal pregnancy tissue. Your provider will monitor the pregnancy hormones in your blood to make sure that you are no longer pregnant. If the ectopic pregnancy is diagnosed later, or if you're in severe pain or having heavy bleeding, you may need surgery to have the tube opened and the pregnancy extracted, or you may need to have part of the fallopian tube removed.
It's scary to have an ectopic pregnancy, but you may also feel sadness because the pregnancy cannot continue. But remember this: More than half of all women who have had an ectopic pregnancy in the past go on to have one or more healthy pregnancies in the future.
Originally published in You & Your Baby: Pregnancy.
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