Ectopic Pregnancies: Signs, Symptoms, and Causes

Pregnancy starts with an egg being fertilized by a sperm. Usually, the fertilized egg (embryo) attaches itself to the uterus lining; however, in ectopic pregnancies, the attachment of an embryo occurs outside of the uterine cavity, mainly in the fallopian tube. Ectopic pregnancy symptoms could generally lead to complications and usually carry a high mortality and morbidity rate if not recognized and treated promptly. Ectopic implantations can also occur in the cervix, ovaries, and abdominal cavity. Women with post-surgical changes to their fallopian tubes are usually at risk for ectopic pregnancies as the primary function of the fallopian tubes is altered post-surgery. 

Signs and Symptoms of an Ectopic Pregnancy

One may not notice any signs and symptoms of ectopic pregnancy at the start. However, as the pregnancy progresses, the signs of an ectopic pregnancy become more apparent. Mostly, the first cautionary signs of an ectopic pregnancy are pelvic pain and some vaginal bleeding. If blood escapes the fallopian tube, one may feel an urge to have a bowel movement or even experience shoulder pain.

If the embryo continues growing in the fallopian tube, it could also cause the tube to rupture, and this could cause severe bleeding in the abdomen. Severe bleeding in the stomach is usually life-threatening, and symptoms could range from light-headedness to shock to fainting.

However, almost 9% of women with ectopic pregnancies do not experience pain, and close to 36% do not share any adnexal tenderness. Thus, the history and physical examination do not diagnose or even exclude an ectopic pregnancy reliably.

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When to See a Doctor

One must seek medical help immediately if there is:

• Pelvic or severe abdominal pain
• Vaginal bleeding
• Shoulder pain
• Extreme light-headedness or fainting

How Soon Can I Get Pregnant After an Ectopic Pregnancy?

In general, it is recommended to wait for a minimum of three months or two complete menstrual cycles before trying to conceive post an ectopic pregnancy. Your medical supervisor will advise you on the same, depending on the complications in the previous pregnancy.

 Typically, after an ectopic pregnancies, the first menstrual cycle comes with a heavy flow, followed by a standard period from the second cycle. An average menstrual period implies that you are healthy hormonally and are ready to conceive again.

 One can have a normal pregnancy after an ectopic pregnancy – a woman can conceive as long as she has one healthy fallopian tube. However, if both the fallopian tubes are removed to treat the ectopic pregnancies, a woman cannot get pregnant naturally unless she opts for IVF.

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 Tests to Prevent an Ectopic Pregnancy

 • Hysterosalpingogram Test: A hysterosalpingogram test is performed to see if the fallopian tube is blocked, which increases the chances of having another ectopic pregnancy.

 • Chlamydia Check-Up: Chlamydia is present in vaginal fluids or infected semen and sexually transmitted infection. Chlamydia increases the chances of ectopic pregnancy, and thus, a chlamydia check-up is done to check for this infection, which can be treated.

Factors that could lead to an Ectopic Pregnancy

Following are some of the factors that could cause an ectopic pregnancy:

• Earlier ectopic pregnancy: There is an increased chance of having a repeat ectopic pregnances if there is a history of previous ectopic pregnancy.
• Infection or inflammation: Sexually transmitted diseases, such as chlamydia or gonorrhea, could lead to inflammation in the tubes and other organs and increase the risk of an ectopic pregnancy.
• Fertility treatments: Research also suggests that women who have gone through infertility treatments such as in-vitro fertilization (IVF) or similar therapies are more likely to have ectopic pregnancies. But the occurrence is quite rare.
• Tubal surgery: Surgery done to correct a damaged or a closed fallopian tube can contribute to the risk of an ectopic pregnancies.
• Age: Advancing maternal age (usually over 35 years) is another factor that could lead to ectopic pregnancies.
• Smoking: Smoking also contributes to the risk of ectopic pregnancies.

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Diagnosis of an Ectopic Pregnancy

Earlier, ectopic pregnancies could only be diagnosed based on clinical symptoms, such as lower abdominal pain and vaginal bleeding. However, this led to a lot of precious time being wasted as early detection decreases the mortality rate. But nowadays, early detection of ectopic pregnancies is possible through Serum Beta-Human Chorionic Gonadotropin (β-hCG) (blood test) and vaginal ultrasonography.

Blood tests alone cannot show where the embryo is developing, but these tests can assist doctors in monitoring patients who may have a growing ectopic pregnancy.

Prevention of Ectopic Pregnancy

Generally, ectopic pregnancies cannot be prevented. However, serious complications that can arise due to such pregnancies can most definitely be prevented with initial diagnosis and treatment. Some precautions one may take to avoid an ectopic pregnancy are:

• If women are aware of any risk factors that they may have for an ectopic pregnancies, their physician should be closely monitored during the first weeks of pregnancy.
• It is recommended to quit smoking while trying to conceive to reduce the risk of an ectopic pregnancy.
• One must practice caution to reduce the risk of any Sexually Transmitted Infections (STIs), such as chlamydia and gonorrhea, that may increase the chances of an ectopic pregnancy. Moreover, if women do contract an STI, then it is essential to seek treatment immediately. The sooner the treatment is provided, the less likely will they develop an inflammation that may harm the reproductive system and increase the chances of an ectopic pregnancy.

Management of Ectopic Pregnancy

• Medical management: Medical treatment is useful for women with an unruptured tubal ectopic pregnancy and those with minimal symptoms with a low volume of free intraperitoneal fluid during ultrasound scans.
• Expectant management: Expectant management means that the pregnancy is expected to resolve itself without having to intervene. The pregnancy is closely monitored by the physician instead of seeking immediate treatment. Women eligible for expectant management of ectopic pregnancy must show no signs of tube rupture, be asymptomatic, and clinically stable with steadily declining β-hCG concentrations (Ectopic pregnancies hCG levels).
• Surgical treatment by laparoscopy or laparotomy: Though there have been various developments in managing an ectopic pregnancies, the surgical treatment by laparotomy to deal with this situation is still the most widely used and opted for treatment. This treatment prevents any complications leading to mortality. Laparoscopic procedures mean quicker operative times, reduced intraoperative blood loss, and brief hospital stays.

As ectopic pregnancies cannot be prevented, the only option we have at hand is caution. Thus, to avoid such an experience, let us put our knowledge to the best use and increase the chances of a happy and healthy pregnancy.

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