After fertilization, the egg typically travels to the uterus, where it implants in the lining, grows, and develops. In rare cases, however, it implants outside the uterus—most often in the fallopian tube. In the first few weeks, the pregnancy may not feel any different from a typical one. However, an ectopic pregnancy cannot be carried to term, and serious complications can sometimes occur. Here, you’ll learn how an ectopic pregnancy happens, how to recognize it, and what 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. The egg usually travels through the fallopian tube toward the uterus for three to five days after fertilization, where it then implants. However, if the fallopian tube is not fully open, the egg may get stuck along the way and instead implant in the lining of the fallopian tube. In addition, the embryo can sometimes implant in other locations outside the uterus, such as the ovaries, the cervix, or the abdominal cavity. Because an embryo can only be adequately supplied within the uterus, Ectopic pregnancies —in which the embryo implants outside the uterus—cannot be carried to term. Most therefore end early in a spontaneous Miscarriage , which in many cases goes unnoticed.

At 86 percent, ectopic pregnancy is the most common form of extrauterine pregnancy. Even if that sounds like a lot at first, an ectopic pregnancy occurs in only one to two percent of all pregnancies .

Causes

Most ectopic pregnancies are caused by reduced patency of the fallopian tubes. Various factors 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.

• Fallopian tubes that are stuck or bent, for example, due to surgery 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 cilia movement, as can hormonal imbalances caused by fertility treatments, the morning-after pill, or contraception with the progestin mini-pill.

Signs

At first, an ectopic pregnancy can cause typical pregnancy symptoms, such as a missed period and tender breasts. Even if you take a pregnancy test, it will come back positive. This is because the placenta—which also develops in an ectopic pregnancy, as it does in a typical pregnancy—begins producing the pregnancy hormone hCG. For this reason, it can be difficult in the first few weeks to determine whether the fertilized egg has implanted in the fallopian tube. Clear signs of an ectopic pregnancy usually appear between the sixth week 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

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. Inflammation of the appendix, the renal pelvis, the ovaries, or the fallopian tube itself can also cause similar discomfort. If you notice any of these signs, contact your doctor immediately—or go straight to the emergency room if you have severe pain—so the cause can be determined.

Diagnosis and Treatment

If an ectopic pregnancy is suspected, your doctor will perform a thorough examination and check for possible risk factors. During a vaginal pelvic exam, they can examine your uterus, fallopian tubes, and ovaries to see whether 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, hCG 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, a molar pregnancy—or often an ectopic pregnancy—may be 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, if it does not resolve on its own, must be medically ended to prevent complications. Treatment after diagnosis depends on the exact location of implantation and how far along the pregnancy is. In the early stages, medication can be used to end the pregnancy; in rare cases, you may also be advised to wait under medical supervision to see whether 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 support future pregnancies.

History and complications

Many ectopic pregnancies end on their own very early, 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, because 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. The embryo may continue to grow until the seventh or eighth week of pregnancy, until the fallopian tube ruptures and severe, acute bleeding occurs. This can lead to bleeding into the abdominal cavity, which in the worst case can be life-threatening. If you experience the following warning signs, contact your doctor immediately or go straight to the emergency room. 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 today are so effective 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 deep grief for many affected women. Many also feel guilty—but an ectopic pregnancy is never due to the mother’s misconduct. Keep this in mind, and seek help if these thoughts weigh on 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 support for psychological stress.

Unfortunately, preventing an ectopic pregnancy is not possible, aside from avoiding infections. If you’re concerned that your pregnancy might be ectopic, it’s best to contact your gynecologist early. They can check whether your pregnancy is progressing healthily and may be able to ease your worries.

Many women who have already experienced an ectopic pregnancy worry about how a subsequent pregnancy will progress. The good news is that, with proper treatment, complete healing of the fallopian tubes is possible and does not prevent a future pregnancy. After a (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 whether it can pass through both fallopian tubes and whether they are therefore 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 how you feel.

Whatever your journey so far looks like, and wherever it may lead you, we wish you all the best and strength along the way.