Ectopic Pregnancy

Ectopic Pregnancy Explained

Find out how an ectopic pregnancy develops, and learn why it can be difficult to diagnose.

Singer-songwriter Vanessa Carlton opens up about a personal health crisis that could have been fatal. Just a few weeks into her first pregnancy, Vanessa says she felt like something was wrong. She felt an ache on one side of her abdomen and had some light spotting.

As she has polycystic ovary syndrome (PCOS), which can affect fertility, she began tracking her hormones regularly, as one would do during a high-risk pregnancy. She also insisted on an early ultrasound, which was inconclusive. A few days later, she says she started to feel cramping and a sharp pain in her shoulder.

“It felt like lightning hit my shoulder, and I screamed out,” she says. “That was an indication of internal bleeding. There [was] blood in the stomach, pushing on that nerve.”

Vanessa was diagnosed with an ectopic pregnancy and rushed into surgery. Her doctor, OB-GYN Dr. Isabel Blumberg joins The Doctors via polycom to explain the surgery, which removed Vanessa’s right fallopian tube, and saved her life.

OB-GYN Dr. Jennifer Ashton says, “This is something that … is very, very important to diagnose, but can be very difficult to diagnose.”

An ectopic pregnancy occurs when a fertilized egg gets stuck on its way to the uterus and attaches somewhere outside of the uterus, typically in a fallopian tube, but can also occur in the abdominal cavity or cervix. This occurs in approximately one to two percent of pregnancies in the U.S., according to the Centers for Disease Control and Prevention. An ectopic pregnancy cannot proceed normally, as the fertilized egg will not survive outside of the uterus. Furthermore, it can be dangerous to the mother if left untreated, accounting for three to four percent of pregnancy-related deaths. Early treatment helps preserve the chance for a future healthy pregnancy.

Symptoms of Ectopic Pregnancy
At first, the condition may not have any signs or symptoms.
  • Symptoms usually appear between 5-14 weeks of pregnancy
  • Other symptoms may be the same as those of normal pregnancy. (e.g. missed period, breast tenderness, nausea)
  • Abdominal/pelvic pain and light vaginal bleeding are the first warning signs
  • Urge to have bowel movements can occur
  • Heavy bleeding only occurs if pregnancy occurs in cervix
  • One-sided abdominal pain, which can be persistent and severe
  • Vaginal bleeding that is different from your regular period
  • Shoulder tip pain
  • Abdominal pain during urination and bowel movements
  • Diarrhea and vomiting

Symptoms of Ectopic Pregnancy Rupture

  • Heavy bleeding in abdomen
  • Fainting or feeling lightheaded
  • Low blood pressure
  • Pain in the shoulder area
  • Severe, sharp and sudden pain in the lower abdomen and intense pressure in the rectum

Possible Causes

  • Defect in the fallopian tubes
  • Scarring after a ruptured appendix
  • Endometriosis
  • History of previous ectopic pregnancy
  • Scarring from past infections or surgery of the female organs

Hormonal imbalance and/or abnormal fetal development may also play a role.

Treatment Options
Ectopic tissue must be removed If detected early. An injection of methotrexate can stop cell growth/dissolve existing cells. Laparoscopic surgery is often required to remove ectopic tissue and repair the fallopian tube(s).

Sources: Mayo Clinic, NIH, NHS, CDC