Ectopic Pregnancy

By Dr. Loretta Lanphier, ND, CN, HHP, CH

A lost pregnancy is painful under any circumstances, especially when it appears that everything is proceeding normally. One form of unsuccessful pregnancy is called ectopic, and it is a very serious situation that can have potentially life threatening consequences for the mother. It can also make it difficult for a woman to have a normal pregnancy in the future. The good news is that most ectopic pregnancies can be prevented by making wise health and lifestyle choices that include avoiding both promiscuity and the use of artificial hormones such as those found in many forms of birth control. It is important to have a basic understanding of this significant medical issue, including ways to minimize your risk for developing it.

What is Ectopic Pregnancy?

The term ectopic literally means “in an abnormal place or position.” An ectopic pregnancy is just that—the body attempting to produce a fetus from a fertilized egg that has attached itself outside of the uterus. The vast majority of ectopic pregnancies occur in the fallopian tubes and are known as “tubal pregnancies.” However, a small percentage of ectopic pregnancies are also found in the ovaries, cervical canal, or abdomen.

Ectopic pregnancies were first discussed in medical literature dated from the eleventh century. Before the widespread use of such procedures as surgery and blood transfusions, ectopic pregnancy was an almost certain fatal condition. In modern times, the earlier the condition is diagnosed, the better chance a woman has of surviving and keeping her ability to normally conceive intact. However, the condition is still the leading cause of pregnancy-related deaths in the United States, accounting for approximately 9% of all such fatalities. How common are ectopic pregnancies? Currently, the rate of incidence is about 2% (roughly 20 out of every 1000 pregnancies), but this has been increasing in the last few decades due to factors we will discuss later in this article.

Ectopic pregnancy is a condition that needs immediate medical care. Without intervention, the misplaced fetus can cause great damage to internal reproductive organs of the mother, and if a rupture occurs, usually of the fallopian tubes, dangerous bleeding can endanger her life. The mother’s reproductive system can also be harmed, making it difficult for her to have a normal pregnancy or increasing risk for complications if pregnancy does occur.

What Are the Signs and Symptoms of an Ectopic Pregnancy?

By all appearances, many ectopic pregnancies are normal, at least initially. Typical signs of early pregnancy including a missed period, nausea, fatigue, breast tenderness, etc., usually accompany an ectopic pregnancy, causing no indication that anything is awry. However, as the fertilized egg or zygote or embryobegins to grow, it becomes impossible for the pregnancy to continue normally, and certain symptoms typically occur. These include:

  • Vaginal bleeding (often to a light degree at first)
  • Pain in the lower abdomen
  • Cramping on one side of the pelvis (depending on which side the ectopic pregnancy has occurred)

More extreme signs may appear if the fallopian tube bursts, a common complication of ectopic pregnancy. If this happens, patients may experience:

  • Sharp, stabbing pelvis pain
  • Possibly pain in the shoulders or neck as well
  • Fainting
  • Dizziness or lightheadedness
  • Internal hemorrhaging that can be life threatening

How Does an Ectopic Pregnancy Occur?
In a normal potential pregnancy situation, an egg travels from the ovary to one of the fallopian tubes, where if pregnancy is to occur, fertilization then takes place. This “zygote” then continues on its journey through the fallopian tube and enters the uterus within several days. It attaches itself to the wall of the uterus, and the cells of the zygote will soon form both the placenta and the embryo, At this point a normal pregnancy is under way. An ectopic pregnancy happens when the fertilized egg is unable to proceed down the fallopian tube and find its way into the uterus. The majority of the time, the zygote abnormally embeds itself into the wall of the fallopian tube, and a tubal pregnancy has occurred. Tubal pregnancies account for more than 95% of all ectopic pregnancies. About 1.5% are found in the abdomen, and less than 1% develop in the ovaries or cervix. Often times the fallopian tube in which ectopic pregnancies are found are scarred or misshaped in some way, and the fertilized egg is physically unable to complete its journey to the uterus.

What Causes an Ectopic Pregnancy?

It is difficult to pin down the precise reason why an ectopic pregnancy develops in many cases. However, there are several risk factors that can increase the likelihood of one occurring. Some of the most common factors include:

  1. Pelvic Infections:  A common thread in about 50% of ectopic pregnancies is that the mother has experienced some form pelvic infection or inflammation. This often takes the form of pelvic inflammatory disease (PID), which is a family of conditions that can affect the uterus, ovaries, or the  fallopian tubes (called salpingitis in this location). PID and other infections of the reproductive tract can result in scarring or other damage to the fallopian tubes which then increases the statistical chances of an ectopic pregnancy occurring. PID is most often contracted via sexual intercourse, typically with multiple partners. It is also commonly associated with the Sexually Transmitted Diseases (STDs) gonorrhea or chlamydia. Thus, one of the best ways to protect yourself from ectopic pregnancies is to have a monogamous sexual relationship and to avoid other behaviors that may expose you to STDs.
  2. Artificial Hormones:  Exposure to hormones used in Hormone Replacement Therapy (HRT), birth control pills, or possibly through dietary sources such as soy can affect the lining of the fallopian tubes and make it more difficult for fertilized eggs to complete the journey into the uterus. The use of fertility drugs that are designed to stimulate ovulation with hormonal influences can also increase risk for ectopic pregnancies. It is also known that if a woman becomes pregnant despite the use of birth control pills, her chances are much greater for an ectopic pregnancy to develop. The health considerations are very significant regarding the use of artificial hormones because of the way they throw off the natural hormonal balance within the body.
  3. Intrauterine Device (IUD): The use of an IUD may also increase risk for ectopic pregnancy. They are statistically quite effective at preventing implantation of a fertilized egg in the uterus, but eggs that are fertilize will often end up finding a home outside of the uterus. This is even a bigger problem with IUDs that  also emit progesterone. Approximately 15% of women using such devices will experience an ectopic pregnancy.
  4. Tubal Litigation:  Having your “tubes tied” as a means of birth control will also increase your risk. Just as with an IUD or birth control pills, if pregnancy should occur after a tubal litigation, the chances are greater than normal that it will be ectopic. This is also true for tubal sterilization, whereby the fallopian tubes are severed to prevent pregnancy. This procedure can sometimes be reversed, but pregnancies that result after such reversal surgery have an increased risk for being ectopic.
  5.  Endometriosis:  This is a somewhat common condition that involves abnormal growth of the uterus lining that results in it developing outside of the uterus. One of the potential complications of endometriosis is blockage of fallopian tubes, and thus increased risk for ectopic pregnancy.
  6. Mother’s use of diethylstilbestrol (DES):  If a woman’s mother used DES (a now-banned drug that was once prescribed during pregnancy), it can potentially cause damage to her fallopian tubes that may increase the chances of ectopic pregnancy.

How Do I Know if My Pregnancy is Ectopic?

If an ectopic pregnancy is suspected, there are several fairly reliable tools available that can confirm the diagnosis. The most common ones include:

  1. Pelvic examination:  This is usually the first step. Often a health care provider can determine if a pregnancy is developing outside of the uterus simply by palpitating the area. This is only helpful if the pregnancy has come along far enough to enable a mass to be felt.
  2. Sonogram:  This imaging technology, which is generally safe for mother and baby if administered properly, can give visual proof of whether a pregnancy is ectopic or not. In some cases, ultrasound equipment must be inserted into the vagina to get a good reading, especially very early in pregnancy. Sonograms are typically useful only after five weeks of gestation.
  3. Blood tests:  One of the most definitive tests measures blood levels of a hormone called human chorionic gonadotropin (hCG). In normal pregnancies, hCG levels double about every two days during the first ten weeks. If this pattern is not occurring, it is a good indicator that an abnormal pregnancy is developing. To get an accurate test, blood must be drawn and analyzed over a period of several days. Another test that may be helpful is the measurement of progesterone levels in the blood. Abnormally low readings can also indicate a problem with the pregnancy.

How Can an Ectopic Pregnancy Be Treated?

The front line treatment of conventional medicine is a drug called methotrexate that is administered to destroy the cells of the abnormally developing fetus. As with most medications, there are potentially dangerous side effects associated with this medication. It can be very toxic to the kidneys, liver, and bone marrow, and can lead to serous complications in some cases.

Due to the dangerous effects of an ectopic pregnancy, the abnormal fetus must be removed. If you choose not to use methotrexate or if it does not work, surgery must be performed. The least invasive form is called laparoscopy, and it can usually be done on an outpatient basis under local anesthesia. If a more serious condition exists, such as a ruptured fallopian tube, a procedure called a laparotomy is usually done which requires general anesthesia and a stay in the hospital.

Can Ectopic Pregnancies Be Prevented?

Not all ectopic pregnancies can be prevented, but certain factors can be avoided that will minimize the risk. The best thing you can do to help ensure a normal, healthy pregnancy is to live a lifestyle of common sense that does not expose you to STDs. Such steps will prevent a multitude of associated health problems as well. In addition, stay away from artificial hormones in any form. As with many other diseases and medical conditions, pursuing a lifestyle of wellness will produce the fruit of good health so that you will not have to battle disease. Prevention is truly the best antidote to disease.

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