Ectopic Pregnancy: The Importance of an Ultrasound

The importance of an ultrasound cannot be overstated. Beginning at six weeks of pregnancy, an ultrasound can detect the growing fetus. This allows healthcare professionals to determine whether or not a pregnancy will be viable (1). “In a normal pregnancy, the fertilized egg implants and develops in the uterus. In an ectopic pregnancy, the egg implants somewhere other than the uterus — often, in the fallopian tubes” (2). Ultrasounds in early pregnancy can save lives. Early detection alerts patients about potential ectopic pregnancies.

The womb is specially created to hold and nurture a growing fetus. If a fertilized egg implants somewhere other than the uterus, the female body cannot support it. As it grows, it will likely burst the organ containing it, endangering the mother’s life (2). Ectopic pregnancies will not grow or develop into a live birth (2). 

Signs and Symptoms of an Ectopic Pregnancy

An ectopic pregnancy will feel the same as a normal pregnancy, especially in the first trimester. Women will experience the typical symptoms of early pregnancy. This includes breast tenderness and a missed period, accompanied by a positive pregnancy test. From there, signs of ectopic pregnancy will become more obvious (3). Keep in mind, they are rare, occurring in only 11 out of every 1,000 pregnancies. If left untreated, though, these pregnancies can become dangerous (3). 

Women may experience light vaginal bleeding and pelvic pain. Symptoms of an ectopic pregnancy will vary depending on where the egg has implanted. If the fertilized egg attaches to a fallopian tube, it is called a tubal pregnancy. When the fertilized egg is growing in the fallopian tube, shoulder pain may accompany the need for a bowel movement (4). If the egg continues to grow in the fallopian tube, the pregnancy can end in a ruptured ectopic pregnancy. This medical emergency can cause heavy bleeding and light-headedness, along with fainting (4). 

Causes of an Ectopic Pregnancy

There are a few known risk factors that make an ectopic pregnancy more likely. Women who have had in vitro fertilization may have a higher risk of an ectopic pregnancy. Previous tubal pregnancies can also increase the chances of repeat ectopic pregnancies. Inflammation or infection in your tubes and other organs can also make this more likely. Tubal surgery and the use of intrauterine devices (IUDs) can increase the risk of an ectopic pregnancy. Smoking also raises the risk. Also, if a pelvic inflammatory disease is left untreated, scar tissue can prevent the fertilized egg from making its way through the fallopian tubes and into the uterus, causing a tubal pregnancy (5). 

Diagnosing an Ectopic Pregnancy

To officially diagnose an ectopic pregnancy, doctors will run blood tests and an ultrasound. A transvaginal ultrasound enables doctors to use sound waves to locate the fertilized egg (6). An abdominal ultrasound will enable doctors to confirm your pregnancy or to check for internal bleeding (6).

A blood count will be done to check for anemia or blood loss. This will enable healthcare providers to confirm if you are experiencing internal bleeding. The count will also help doctors determine whether or not you need a blood transfusion (6). 

Treating an Ectopic Pregnancy

Medical treatments vary depending on when the ectopic pregnancy was detected. Doctors will also take your symptoms into account and discuss treatment options they think best suit your situation (6). 

Expectant Management

Doctors will recommend expectant management if your symptoms are mild. In this case, it is quite likely the pregnancy will miscarry by itself (6). With this treatment, you’ll have regular blood tests to ensure your hCG (human chorionic gonadotropin) levels are going down. Vaginal bleeding and pain in your abdominal cavity can occur. Follow-up appointments will enable doctors to monitor the ectopic pregnancy. If symptoms worsen, you and your doctor may consider other treatment options (6). 

Methotrexate

Methotrexate is a drug used to stop a pregnancy from growing. This medication is a single injection, after which you can return home. Again, regular blood tests will ensure that treatment is working (6). It’s also important to use a reliable contraceptive for three months following the injection. Methotrexate can harm a baby if you become pregnant during this time (6).

Surgery

In surgery, a laparoscopic procedure is used. Your surgeon will make a small incision to insert a surgical instrument to permit the surgical procedure. These small cuts will enable doctors to remove the fertilized egg before it becomes too large. In some cases, the entire fallopian tube containing the pregnancy is removed. This is not thought to lessen your chances of becoming pregnant again (6). 

If your fallopian tube ruptures, you must have emergency surgery. This is to stop the bleeding and repair your ruptured fallopian tube.

Side Effects of an Ectopic Pregnancy

Healing from an ectopic pregnancy can look different depending on the treatment used. In many cases, side effects of ectopic pregnancy could continue for a few weeks following treatment (7). These side effects may include: 

• Pain in lower abdomen
• Bloating
• Extreme tiredness
• Vaginal bleeding
• Fertility issues
• High hCG levels, causing your body to still feel pregnant
• Psychological effects

If side effect symptoms worsen over time, contact your doctor. 

Healing from an Ectopic Pregnancy

Healing from ectopic pregnancies will differ from individual to individual. In some cases, depending on treatment, physical healing can take from four to six weeks (7). To help with physical recovery, stay away from heavy lifting. Avoid strenuous activity or running or walking long distances. Give your body a chance to physically heal from the pregnancy. 

Emotional healing will need to take place as well. Oftentimes, women can experience feelings of grief after an ectopic pregnancy. Post-traumatic stress, anxiety, and depression can result after treatment of an ectopic pregnancy (7). Support is available, whether through counseling, support groups, or personal self-care. The most important thing is to be gentle with yourself. Give yourself time for the recovery you need.

Common Myths about an Ectopic Pregnancy

As with anything, there are plenty of misconceptions about ectopic pregnancies. Plenty of evidence exists to debunk these myths. 

Myth #1: Medically, treating ectopic pregnancies is the same as abortion

The CDC defines abortion as a termination of a pregnancy within the uterus (8). Ectopic pregnancies occur outside of the uterus.

The abortion pill does not treat ectopic pregnancy. The FDA received reports of two deaths from ectopic pregnancy after mifepristone (abortion pill) use (9). The medication used for abortions is different than the medication used for the removal of ectopic pregnancies (9).

Myth #2: Morally, treating ectopic pregnancies is the same as abortion

Motives behind the removal of a pregnancy make a difference, especially when it comes to an issue of morality. The termination of an ectopic pregnancy is done to save a mother’s life. Without the removal, the fertilized egg would continue to grow and rupture the mother’s organs. Ectopic pregnancies are also not viable. There is not a chance that the fertilized egg could continue to grow and mature outside of the uterus (4).

In contrast, elective abortion is not necessary to save the life of a mother. Abortion is the removal of a live, healthy baby. 

Myth #3: Legally, treating ectopic pregnancies is the same as abortion

Each state defines abortion, and each of these definitions exclude ectopic pregnancies. Each state makes exceptions to preserve the life of the mother (10). The removal of a deceased baby, or an unviable pregnancy, is not the same as the removal of a live, healthy baby.

Final Thoughts About Ectopic Pregnancies

Ultrasounds exist to help detect conditions such as ectopic pregnancies. Taking initiative and asking for an early ultrasound could save your life. If you are experiencing abdominal or pelvic pain and spotting, you may be experiencing one of the rare cases of an ectopic pregnancy. 

An early diagnosis will ensure the quickest and easiest recovery. Make your health a priority and schedule an early ultrasound.

Sources

1. Horsager-Boehrer, Robyn. (2018, November 20). Patience is Key: Understanding the timing of early ultrasounds. UT Southwestern Medical Center. https://utswmed.org/medblog/patience-key-understanding-timing-early-ultrasounds/ 
2. Hirsch, Larissa. (n.d.) Ectopic Pregnancy. Kids Health. https://kidshealth.org/en/parents/ectopic.html
3. Geburtshilfe Frauenheilkd. 2020 Jul; 80(7): 686–701. Published online 2020 Jul 14. doi: 10.1055/a-1181-8641
4. Mayo Clinic Staff. (2022, March 12). Ectopic Pregnancy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088
5. Mayo Clinic Staff. Pelvic Inflammatory Disease. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pelvic-inflammatory-disease/symptoms-causes/syc-20352594 
6. NHS. (2022, August 23). Treatment, Ectopic Pregnancy. NHS. https://www.nhs.uk/conditions/ectopic-pregnancy/treatment/
7. Ectopic Pregnancy Trust. (n.d.) Physical Recovery. https://ectopic.org.uk/physical-recovery 
8. Center  for Disease Control and Prevention. (2021, November 22). CDCs Abortion Surveillance System FAQs. CDC. https://www.cdc.gov/reproductivehealth/data_stats/abortion.htm
9. Food and Drug Administration. (n.d.) Questions and Answers on Mifeprex. FDA. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/questions-and-answers-mifeprex
10. Flanders, Nancy. (2022, June 28). FACT: Treatments for miscarriage and ectopic pregnancy are legal in every state. Live Action. 
    https://www.liveaction.org/news/treatments-miscarriage-ectopic-legal-state/