A guide to ectopic pregnancy treatment and aftercare - Ruth Health

A guide to ectopic pregnancy treatment and aftercare

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Fast facts:

  • The implantation of a fertilized egg in the uterus is a critical step in every pregnancy.
  • An ectopic pregnancy happens when an embryo implants outside of the uterus, most commonly in a fallopian tube.
  • An embryo cannot survive outside of the uterus, and all ectopic pregnancies require treatment in the form of medication or surgery.
  • The likelihood of carrying a healthy pregnancy to term after an ectopic pregnancy depends on your individual health history, including how the previous ectopic pregnancy affected your reproductive organs.
  • Pregnancy loss of any kind can bring many intense feelings to the surface. After an ectopic pregnancy, it’s important to give yourself the time and space to process your emotions.

In a healthy pregnancy, a fertilized egg grows in the uterus. The implantation of a fertilized egg, or embryo, in the uterine lining is a critical step in the biological process of pregnancy.

An ectopic pregnancy happens when an embryo implants outside of the uterus, most commonly in a fallopian tube. Prompt treatment, in the form of medication or surgery, is necessary, as ectopic pregnancies cannot progress normally and carry the potential for serious health complications.

Here’s more on the signs and causes of ectopic pregnancies, aftercare and support resources.

What is an ectopic pregnancy?

An ectopic pregnancy occurs anytime an embryo grows outside of the uterus. 90% of all ectopic pregnancies occur in a fallopian tube. This is called a tubal ectopic pregnancy. They can also happen in the ovary, abdominal cavity, or cervix.

No embryo can survive outside of the uterus, and regardless of where an ectopic pregnancy develops, it cannot support the healthy development of a fetus.

The growth of tissue in any other part of the female reproductive system can lead to life-threatening complications, including severe internal bleeding and, in the case of a tubal ectopic pregnancy, ruptured fallopian tubes.

What are the symptoms of an ectopic pregnancy?

The earliest signs of an ectopic pregnancy resemble those of a healthy pregnancy, including the absence of a menstrual cycle, tender breasts, and nausea. It will also give a positive pregnancy test.

Symptoms of an ectopic pregnancy often become more noticeable as the embryo grows outside of the uterus. The earliest warning signs are typically vaginal bleeding and mild pain in the pelvis.

These symptoms should be reported to your OB/GYN or other trusted health professional, as it can be difficult to differentiate between a typical pregnancy and ectopic pregnancy.

Leaking blood from a ruptured fallopian tube can lead to more serious symptoms that warrant immediate medical attention:

  • Shoulder pain
  • More severe pain in the abdomen or pelvis
  • Weakness, dizziness, or fainting

What are the risk factors and causes of ectopic pregnancies?

There are several reasons why a fertilized egg grows in a fallopian tube rather than the uterus in a tubal ectopic pregnancy:

  • Misshapen or damaged fallopian tube
  • Hormonal imbalances
  • Abnormal embryo development

Common underlying health risk factors of an ectopic pregnancy include:

  • A previous ectopic pregnancy
  • Previous fallopian tube surgery including tubal ligation
  • A history of pelvic inflammatory disease (PID)
  • A history of endometriosis
  • A history of infertility
  • The presence of an intrauterine device (IUD) during conception

Additional risk factors include:

Any woman of reproductive age who is sexually active may experience an ectopic pregnancy. Many individuals have one without identifiable risk factors. It’s important to stay attuned to any changes in your body if you are sexually active.

How is an ectopic pregnancy diagnosed?

There isn’t one single test or procedure used to diagnose an ectopic pregnancy. If your OB/GYN or other trusted health professional suspects an ectopic pregnancy, there are several steps used in the diagnosis process, including:

  • A pelvic exam, which can help rule out other health conditions
  • An ultrasound, which can determine if an embryo is growing in the uterus
  • A blood test for levels of human chorionic gonadotropin (hCG) and progesterone, two pregnancy hormones

If the ultrasound does not detect an embryo in the uterus and your levels of hCG and progesterone decrease or remain steady, an ectopic pregnancy is likely.

When there are more serious symptoms of an ectopic pregnancy, a doctor may recommend emergency surgery to treat fallopian tube rupture without completing the steps above.

How is an ectopic pregnancy treated?

It is not possible to transfer an embryo to the uterus after it starts to grow in another reproductive organ or structure. All ectopic pregnancies require treatment in the form of medication or surgery.

If there aren’t signs of a ruptured fallopian tube, the common starting point for treatment is an injectable medication called methotrexate, which stops the embryo and tissue from growing to end the pregnancy.

Methotrexate requires ongoing monitoring of your hCG levels. This may not be possible in some cases — for example, if you are breastfeeding or have a liver-related health condition — in which case your provider will recommend an alternative treatment option.

After the initial dose of methotrexate, your provider will use your hCG levels to determine if another dose is necessary. Follow-up will continue until you no longer have any amount of hCG in your body.

Emergency surgery is necessary to treat serious ectopic pregnancy complications, including ruptured fallopian tubes. Some surgeries remove the embryo from the fallopian tube while others remove the entire tube along with the embryo.

These procedures are typically performed by laparoscopy, which inserts a small camera with a thin light source through the abdomen, under general anesthesia.

Whether your treatment consists of surgery or medications, recovery is a gradual process. The body takes time to transition back into fertility after beginning to grow a baby.

During this transition, your body will flush hormones and uterine tissue. You may experience fatigue, abdominal discomfort or pain, and other miscarriage symptoms. Additionally, your menstrual periods may take several cycles to return to normal.

Be sure to surround yourself with support as you recover. Along with your friends and family, doulas can help you navigate the physical and emotional aspects of an ectopic pregnancy.

Ask A Doula by Ruth Health is a new service that offers unlimited texting access to a doula. You can get personalized support with postpartum planning, feeding, and anything else pregnancy or postpartum-related. Spaces are limited, so sign up today!

How does an ectopic pregnancy affect future pregnancies?

Many individuals who have had an ectopic pregnancy go on to have a healthy pregnancy and give birth. The likelihood of carrying a healthy pregnancy to term after an ectopic pregnancy depends on your individual health history, including how the previous ectopic pregnancy affected your reproductive organs.

If your fallopian tubes are undamaged, an egg can be fertilized and travel naturally to the uterus. This may be possible even if only one fallopian tube is intact.

Surgery to treat an ectopic pregnancy can scar the fallopian tubes, increasing the likelihood of a future ectopic pregnancy.

Many individuals whose fallopian tubes were damaged or removed as the result of an ectopic pregnancy are able to conceive through in vitro fertilization (IVF). This is a procedure in which a fertilized egg is implanted directly into the uterus.

A history of any ectopic pregnancy increases your risk of having another. If you become pregnant again, it’s important to be aware of any physical changes until your doctor or other health professional confirms that the embryo is growing in your uterus.

The importance of support

Pregnancy loss of any kind can bring many intense feelings to the surface, even if you weren’t trying to conceive. Healing is both an emotional and physical process.

Take care of your mind and body after this loss. Give yourself the time and space to process your emotions. You can ask a healthcare provider or trusted professional about pregnancy loss support groups or a referral for therapy.

Ruth Health is here to provide you with expert, evidence-based maternal care and advice. Interested in learning more about a particular topic? Send us an email at hello@ruthhealth.com.

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