Ectopic Pregnancy: Symptoms, Causes and Risk Factors

Experts explain ectopic pregnancy, also known as tubal pregnancy, so you can recognize the signs of a dangerous "out of place" implantation.

About 1 to 2 percent of all pregnancies in the U.S. are ectopic, which means "out of place." Though rare, the condition involving your fallopian tubes is the most dangerous cause of bleeding in the first trimester and can be life-threatening. Here’s what you should know.

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What Is Ectopic Pregnancy?

An ectopic pregnancy occurs when a fertilized egg implants anywhere outside of the uterus—typically a fallopian tube, which is why it’s also known as a tubal pregnancy—and begins growing.

"Typically this happens if your fallopian tube is blocked by scar tissue or has an abnormality," writes Laura Riley, M.D., director of labor and delivery at Massachusetts General Hospital, in You and Your Baby: Pregnancy.

The egg can also implant in an ovary, the cervix, or the abdomen—none of which have the required space or the right tissue for a pregnancy to develop.

“An ectopic pregnancy is extremely dangerous because it can rupture the fallopian tube and lead to severe bleeding and possibly death,” says Yen Tran, M.D., an ob-gyn at MemorialCare Orange Coast Medical Center in Fountain Valley, California. 

Most ectopic pregnancies are diagnosed in time to prevent this, but in the U.S., the condition still causes about 50 deaths a year, Dr. Riley notes.

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Ectopic Pregnancy Causes

It’s not always known why an ectopic pregnancy occurs, but damage to the fallopian tube could prevent the egg from making it to the uterus. You are more likely to have an ectopic pregnancy if you have one of the following risk factors:

  • Previous ectopic pregnancy 
  • Pelvic inflammatory disease (PID)
  • Previous pelvic or abdominal surgery, such as removal of an ovarian cyst
  • Pregnancy after reversal of tubal ligation
  • Pregnancy through in vitro fertilization (IVF) or fertility drugs
  • Certain STIs, such as chlamydia or gonorrhea
  • Endometriosis
  • Getting pregnant with an IUD in place
  • Age 35 or over
  • Cigarette smoking
  • Your mother took DES (diethylstilbestrol) while pregnant with you

This doesn’t mean you can’t have an ectopic pregnancy if you don’t have any of the risk factors. About half of women who have an ectopic pregnancy don't have any known risk factors.

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Ectopic Pregnancy Symptoms

Initially, an ectopic pregnancy can have the same symptoms that are typical during normal early pregnancy, such as a missed period, breast tenderness, nausea, and fatigue. As an ectopic pregnancy grows, Dr. Berry-Roberts says women may experience:

  • Sudden, severe, sharp pain in the abdomen or pelvic area
  • Vaginal bleeding
  • Shoulder pain 
  • Fainting or feeling faint
  • Weakness or dizziness

If your only symptoms are mild pelvic pain or spotting, that can be common during early pregnancy, so contact your healthcare provider to schedule an appointment, says Dr. Berry-Roberts. However, heavy bleeding, severe pelvic pain, or feeling lightheaded or unstable on your feet warrants an immediate visit to the emergency room, she says.

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If you're experiencing an odd pain in the tip of your shoulder, it could be caused by internal bleeding that irritates nerves that travel to your shoulders, according to Dr. Riley. You're much more likely to save your fallopian tube—and perhaps your own life—if you treat an ectopic pregnancy early, she says. 

Alert your doctor right away to any risk factors for ectopic pregnancy you may have. She will likely do a pelvic exam, ultrasound, and blood work (to check your hCG levels) to determine if your pregnancy is ectopic.

How to Treat Ectopic Pregnancy 

Unfortunately, an ectopic pregnancy cannot continue. "There isn’t anything the doctor can do to move the pregnancy through the fallopian tube and into the uterus," Dr. Berry-Roberts explains.

A tubal pregnancy is treated with either medication or surgery. With the medicine, Dr. Tran says you’ll receive one or more injections of what’s called methotrexate. It will stop the cells from growing and therefore end the pregnancy. Your body will absorb the cells that have already grown.

The surgical procedure is performed through laparoscopy. That means the doctor will make a small incision near your belly button and use a tiny camera to see and remove the ectopic pregnancy from the tube (or, if necessary, remove the entire tube).

Each method, whether you receive the medication or go through surgery, requires several weeks of follow-up with your doctor.

Getting Pregnant After Ectopic Pregnancy

Having an ectopic pregnancy does put you at risk for having another one, but the good news is 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, according to Dr. Riley. Speak with your healthcare provider to discuss your chances of having a pregnancy that develops in the proper place.

Preventing Ectopic Pregnancy

Sadly, there's no definite way to prevent an ectopic pregnancy.

“However, avoiding conditions that may cause scarring of the fallopian tubes may help reduce your risk,” says Crystal Berry-Roberts, M.D., an ob-gyn at Austin Regional Clinic in Austin, Texas. Her advice: Limit sexual partners, practice safe sex to protect yourself from STIs, and get early diagnosis and treatment for any STIs. It’s also a good idea to quit smoking.

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