Ectopic pregnancy
After fertilization, the egg typically travels to the uterus, where it implants into the lining, grows, and develops. In rare cases, however, it implants outside the uterus, most often within the fallopian tube. In the first few weeks, pregnancy does not differ from a normal one – however, an ectopic pregnancy cannot be carried to term, and serious complications can sometimes occur. Here you will learn how an ectopic pregnancy occurs, how to recognize it, and what the treatment involves.
When does one speak of an ectopic pregnancy?
An ectopic pregnancy (medical Tubal pregnancy ) begins like any other pregnancy with the fertilization of the egg. This usually travels for three to five days after fertilization through the fallopian tube towards the uterus, where it finally implants. However, if the fallopian tube is not completely permeable, it is possible that the egg gets stuck on the way and instead implants in the mucous membrane of the fallopian tube. Additionally, it can also happen that the embryo implants in other locations outside the uterus, such as in the ovaries, in the cervix, or in the abdominal cavity. Since the adequate supply of the embryo is only guaranteed within the uterus, they Ectopic pregnancies , where the embryo implants outside the uterus, are not terminated. Most of them therefore end early with a spontaneous Miscarriage , which in many cases remains unnoticed.
With 86 percent, ectopic pregnancy is the most common form of extrauterine pregnancies. Even if that may sound like a lot at first: an ectopic pregnancy only occurs in one to two percent of all pregnancies .
Causes
Most ectopic pregnancies are due to impaired patency of the fallopian tubes. There are various factors that can prevent the egg from passing through:
Congenital obstructions such as blind-ending side branches or invaginations
Scars and other damage to the mucous membrane, for example caused by fallopian tube inflammation due to infections or endometriosis.
Stuck or bent fallopian tubes, for example due to surgeries in the surrounding pelvis and caused by scarring or adhesions.
Fallopian tube polyps or (benign) tumors of the uterus or fallopian tubes that constrict the fallopian tubes.
Limited mobility of the cilia on the inner wall of the fallopian tubes. These tiny hair-like structures propel the egg through the fallopian tube, ensuring it reaches the uterus. Bacterial infections can impair the mobility of the cilia, as can hormonal imbalances caused by fertility treatments, the morning-after pill, or contraception with the progestin mini-pill.
Signs
Initially, ectopic pregnancy shows normal pregnancy symptoms such as missed periods, and tender breasts. Even if you take a , it will come back positive. The reason for this is that the placenta, which also develops in an ectopic pregnancy, like in a regular pregnancy, begins producing the pregnancy hormone hCG. Therefore, in the first few weeks of pregnancy, it is initially difficult to determine whether the fertilized egg has implanted in the fallopian tube. Concrete signs of an ectopic pregnancy usually only appear between the sixth and, at the latest, the eighth week of pregnancy. These may include the following symptoms:
Increasing, sometimes very severe lower abdominal pain
Bleeding
Dizziness and circulatory problems
Discomfort
Tense abdominal wall
Shortness of breath
Slightly elevated temperature
The symptoms vary from woman to woman, and not all of those listed here necessarily occur. They are also not always definitive signs of an ectopic pregnancy. An inflammation of the appendix, the renal pelvis, the ovaries, or the fallopian tube itself can also be the cause of the discomfort. If you notice any of these signs, you should contact your doctor immediately or go directly to the emergency room in case of severe pain to determine the cause.
Diagnosis and Treatment
If a suspected ectopic pregnancy is present, your doctor will perform a thorough examination and check for possible risk factors that may indicate an ectopic pregnancy. Through a vaginal pelvic exam, they can examine your uterus, fallopian tubes, and ovaries to see if pain in this area or enlarged fallopian tubes suggest an ectopic pregnancy. The development of the pregnancy hormone hCG can also provide clues as to whether the pregnancy is developing normally; in the early weeks, the pregnancy hormone should double every 48 hours if development is normal. Your doctor can measure the hCG concentration in your blood early on: with hCG levels above 2000 IU/l, a pregnancy should be detectable by ultrasound. However, if no gestational sac is visible in the uterus on the ultrasound image, it may be a molar pregnancy, and often an ectopic pregnancy, that is the cause. If other examinations do not provide a clear diagnosis, a laparoscopy can also determine whether it is an ectopic pregnancy.
An ectopic pregnancy cannot be carried to term and must, if it does not resolve on its own, be artificially terminated to prevent complications. The treatment after diagnosis depends on the exact location of the implantation of the fertilized egg and how far along the pregnancy is. In an early stage, medication can be used to terminate the pregnancy; in rare cases, the woman may also be advised to wait under medical supervision to see if the embryo passes naturally. However, ectopic pregnancies are usually treated surgically. During a laparoscopy or through a small incision in the lower abdomen, the embryo along with the surrounding pregnancy tissue is removed. Important: During surgery, your doctor will always aim to preserve the affected fallopian tube as much as possible to enable future pregnancies.
History and complications
Many ectopic pregnancies end very early on their own, usually between the eighth and tenth week of pregnancy. The embryo initially grows, but at a certain point in the fallopian tube, it can no longer develop, and space also becomes limited. The embryo dies, detaches from the wall of the fallopian tube, and is expelled by the body. This can cause bleeding – however, since most ectopic pregnancies end early, often before the pregnancy is even known, many women mistake the bleeding for their period.
In some cases, an ectopic pregnancy can lead to complications, especially if it goes unnoticed and does not resolve on its own. It can happen that the embryo continues to grow until the seventh or eighth week of pregnancy, until the fallopian tube ruptures and severe, acute bleeding occurs. The result can be bleeding into the abdominal cavity, which in the worst case can even be life-threatening. If you experience the following warning signs, you should immediately contact your doctor or go directly to the emergency room, as in the case of a ruptured fallopian tube, immediate surgical treatment is necessary:
Severe lower abdominal pain radiating to the upper abdomen, back, and shoulders
Dizziness, fainting, or circulatory shock due to blood loss
Fortunately, medical examinations nowadays are so good that most ectopic pregnancies are detected in time, and such emergencies are very rare.
What happens after an ectopic pregnancy?
An ectopic pregnancy cannot be saved and often causes great grief for many affected women. Often, those affected feel guilty – but an ectopic pregnancy is never due to the mother's misconduct. Be aware of this and seek help if such thoughts burden you. After an ectopic pregnancy, you are entitled not only to follow-up care for physical complaints, such as after surgery or due to hormonal fluctuations, but also for psychological stress.
Preventing an ectopic pregnancy is unfortunately not possible, aside from avoiding infections. If you have concerns that your pregnancy might be an ectopic pregnancy, it is best to contact your gynecologist early. They can check whether your pregnancy is progressing healthily and possibly alleviate your doubts.
Many women who have already experienced an ectopic pregnancy are afraid of how a subsequent pregnancy will progress. The good news is that complete healing of the fallopian tubes is possible with proper treatment and does not prevent a future pregnancy. After an (repeated) ectopic pregnancy, there are various options to test the patency of the fallopian tubes: either surgically via laparoscopy (
Chromopertubation ) or with the so-called Hysterosalpingography. A contrast agent is injected into the uterus and then checked with ultrasound to see if the contrast agent can pass through both fallopian tubes and if they are thus permeable.
Some doctors recommend waiting three to six months after an ectopic pregnancy before trying to conceive again. Ultimately, this decision depends not only on the course of your pregnancy and your doctor's advice but also on your own feelings.
Whatever your journey so far looks like and where it may lead you: we wish you all the best and much strength on your path.