Ectopic Pregnancy

An ectopic pregnancy is any pregnancy that establishes itself anywhere in the body except within the womb — most commonly in the fallopian tube, but also possibly in the abdominal cavity, ovary, or elsewhere.

A few years ago, I saw a cable TV show on weird pregnancy things, and one of the segments featured an elderly woman in India who, nearly 50 years after she was to have given birth, was finally diagnosed with an ectopic pregnancy. Basically, the baby grew on the outside of the womb instead of the inside, and didn’t have a way to come out. The woman went into labor, and had all the pains; but at the time, she was scared of hospitals (high infection rates and poor quality care) — I think she went to the hospital, but saw one or more women die from a C-section, so she left the hospital rather than submit to a Cesarean, which she thought would kill her (and she was probably right). After a while, labor stopped, and she also never felt the baby move again. Eventually, the baby calcified within her body; and finally, during the filming of the TV show, she was able to find a doctor to remove the mass (which may have caused her some pain or health problems), some 50 years after it died.

More recently, I read about another woman (also from India), who found out during a routine C-section that her baby wasn’t in her womb, but had grown in her ovary.

Ectopic pregnancies can be deadly to the mother — no doubt about that. But the thing that I found interesting is that, while they can be deadly, they can also resolve on their own — something I’d never heard of before. I assumed that most if not all ectopic pregnancies would rupture and kill the mother through hemorrhage; but that’s not always the case. In addition to the very rare instances of babies who survive an ectopic pregnancy (probably higher if the placenta implants on the outside of the womb, rather than other places without such a good blood supply or the danger of hemorrhage), it is also possible for the mother to miscarry naturally without rupture, hemorrhage, and death.

As pro-life as I am, I would not think the less of anyone for choosing an abortion to end an ectopic pregnancy, especially one in the fallopian tube which has a high rate of rupturing if/when the baby gets too big to fit inside it any more. The chance of the baby surviving is very small, in fact, almost nonexistent; and the risk of maternal injury or death is high. I remember thinking of this topic even when I was fairly young — maybe early teens, maybe even a little earlier. Somehow it was brought up in a discussion I was listening to, and the general consensus was that “ectopic pregnancy = maternal and fetal death if no abortion; therefore, abortion saves one life instead of both being taken.” So, case closed, right? Well, sometime after that, I heard of the very small possibility of babies being viable and surviving ectopic pregnancies. So, pro-life as I am, that bothered me — the possibility of killing a baby that would otherwise live and not cause a problem to the mother. And now, to find out that some ectopic pregnancies resolve spontaneously, makes me question my stance even further.

Let me be clear — a friend of mine had an ectopic pregnancy removed along with the affected tube, and I don’t think the worse of her for that. I also assume that (since she is also very pro-life), she asked the doctor if there was any way the baby could be saved, and perhaps did some test(s) to see if that there was absolutely no way; and the removal of the tube was at least partially to keep the same thing from happening again in the future.

But I’ve wondered what I would do if I were diagnosed with an ectopic pregnancy in early pregnancy.

That’s extremely unlikely, for at least two reasons: one — I have no risk factors, except possible DES exposure (although I’m “officially” too young — you can check my DES posts for my multiple long posts on that subject); and two — I don’t get early ultrasounds (or any ultrasounds if I can help it), so I would not be diagnosed until I had the telltale serious abdominal pain which signals an impending tubal rupture. At that point, the baby is usually dead, or it is obvious that abortion is the only option which allows me to live, so there would be no time to think — just do it and be done with it. Heck, I might be already in shock at that point!

In the document I linked to above on ectopic pregnancies, it notes that the incidence of EPs has greatly increased in the past few decades — from 4.5/1000 pregnancies in 1970 to 19.7/1000 in 1992. It attributes the noted increase partially due to increased incidence of risk factors like STDs which cause pelvic inflammation and other female infections; and partly due to better diagnostics. I’m sure part of the “better diagnostics” is due to women knowing for sure that they’re pregnant and starting their prenatal care sooner, and part of it is due to the use of ultrasound in early pregnancy.

When my sister-in-law was late when she was pregnant with her second son, she mentioned in my Grandma’s hearing that she needed to buy a pregnancy test to confirm the pregnancy. My [ultra-frugal] Grandma said, “Why? If you’re pregnant, you’ll figure it out eventually because your periods won’t come back; and if you aren’t pregnant, you’ll start your periods again.” Well, she was pregnant, and she did confirm it by a test — but those tests weren’t available when my Grandma was having babies. I’m not sure if they were easily available when in the 70s. I wonder how many women were actually pregnant and were a few days or a few weeks late and then finally “started their periods” when it was actually a miscarriage. Also, if my Grandma’s attitude prevailed, it would not be uncommon for women to go to 6-8 weeks of pregnancy, or perhaps even longer — maybe even until “quickening” (when the baby’s movement is first felt by the mother) — before knowing “for sure” that they were indeed pregnant.

That same website says that the case-fatality rate of ectopic pregnancies is now about a tenth of what it was in the early 70s — dropping from 35.5 to 3.8 maternal deaths per 10,000 ectopic pregnancies — but of course, that is with diagnosed ectopic pregnancies. If a significant percentage of ectopic pregnancies went undiagnosed (as opposed to today’s early confirmed pregnancies and early ultrasounds that may indicate ectopic pregnancy), and the rate of actual ectopic pregnancy in 1970 was not 4.5/1000, but that was merely the diagnosed rate — if it was really closer to the 1992 rate of 19.7/1000, and most ectopic pregnancies resolved themselves naturally by miscarriage, then the drop in maternal deaths is not as significant. I would assume that all women who died of a tubal rupture and subsequent hemorrhage would have been included in whatever ectopic statistics were kept, regardless of whether their ectopic pregnancies were diagnosed prior to their death or only on autopsy — so the deaths would be accurate, even if the diagnosis was not. But, going on the statistics we have — if there were 4.5/1000 ectopic pregnancies in the 1970s, then out of two million births, there would have been 32 maternal deaths; but with the skyrocketing rate of ectopic pregnancies, in 1992 out of two million births, there would have been 15 maternal deaths — about half the death rate from ectopic pregnancies, based on live births.

That same document said, “To date, at least 14 studies have documented that 68 to 77 percent of ectopic pregnancies resolve without intervention.” Unfortunately, there is no known way to determine which pregnancies will resolve spontaneously, and which will be in the unfortunate minority. Obviously, early detection in most countries and most areas will lead to all ectopic pregnancies being ended by surgery or, now, by medication. Ectopic pregnancies that are diagnosed by the mothers’ symptoms of tubal rupture will, obviously, be in the 1/4-1/3 of pregnancies that have not resolved spontaneously; but ectopic pregnancies that are diagnosed by pre-rupture symptoms or early ultrasound may or may not resolve by themselves. It seems to me that if the pregnancy resolves on its own, then that should be best for the mom — no drugs or surgery. However, if the ectopic pregnancy ruptures, then that is possibly life-threatening for the mother, and will involve much more intervention to save her life or health or future fertility. The article said that with a small pregnancy and declining pregnancy hormones (which indicate a miscarriage is impending or in process), if the mother is willing to be closely monitored, then she may be a candidate for “expectant management.”

Anyway, the topic interested me, so I looked into it, and blogged about it (it’s not medical advice). Ectopic pregnancies can be life-threatening, although they can rarely end in a live baby, and sometimes in a natural miscarriage; although the standard medical course is an abortion once the diagnosis is made.

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10 Responses

  1. Nice article! It’s an interesting subject. I had a friend who had an ectopic pregnancy but did not find out that she was even pregnant until her fallopian tube had ruptured and she was bleeding and in great pain and had to go to the hospital – and thereupon found out that she was pregnant and that emergency surgery was necessary to save her life.

    I read on one pro-life blog the philosophy of “watchful waiting” for an ectopic pregnancy – instead of going straight to surgery, waiting to see if the baby would miscarry or be one of the rare surviving ectopic babies. That does leave the possibility of tubal rupture, but it might give some mums more peace about it. I pray that I’m never faced with that decision – it’s a rough one either way.

  2. Hi –

    I came across your blog and thought you might be interested in this release:

    The GYNECARE PROLIFT+M Pelvic Floor Repair System represents a step forward in the treatment of pelvic organ prolapse (POP). The launch of this product is positioned to be an important advance for many of the approximately 200,000 women who are treated each year for POP in the US. Check out the above URL for more information.

    Many thanks,

  3. I had an ectopic pregnancy rupture at 4 months. The nurse said “it’s not a real baby”. I disagree and I also think that physicians should offer a burial/funeral, which i was not given that option. It is a “real” baby and a “real” loss. Since, I was not given an option to bury my child, my husband and I have agreed that upon my death, there will be a tombstone for myself and my baby “Lillian (Lilly) Paulette”. This decision has absolutely helped me cope with our loss. Hopefully, doctors will be more compassionate to those of us who grieve the loss of a “real” child.

  4. Ectopic pregnancies can be a very difficult topic and event in someones life. Very interesting stories – especially the one in India about a calcified baby – kind of crazy.

  5. As per the first posting, the problem is not whether or not to have an “abortion”, there is no way to save the “fertilized egg” and move it according to the medical community. The problem is that the medical community does not correctly diagnose them or really take the possibility seriously, fails to do followup that the seriousness merits, and does not warn upon suspicion of an ectopic pregnancy that on a moment’s notice the patient could drop dead from the rupture and therefore, it’s vital that she either handle the situation with medication or scheduled removal as soon as it’s clear whether or not the pregnancy is viable, and meanwhile have a phone with her at all times, not travel, not be alone, etc. I nearly died from just such a situation where no warning was given after my ER visit or followups, and then collapsed two weeks later. Had I not been in front of a phone, I would be dead now since I went from happily eating breakfast to unconscious in about 5 minutes. This is a huge problem and ectopics remain the primary cause of death for women in the first trimester.

  6. Most of the ectopic pregnancies take place in the fallopian tubes, this condition is called as tubular pregnancy. If it is not diagonised on time, the woman can face severe bleeding. One should go for regular checking and should consult doctor. Smoking increases the likelihood of ectopic pregnancy, so one should strictly avoid smoking.

  7. I’m going through this experience right now,I’m 4wk pregnant and last week made an app to check some pain in my left side that I’ve had for several months accompanied by spotting in the middle of my cycle, My doctor checked me and suggested an u/s, so 2 days ago I had it done and discover an ectopic pregnancy, . After debating with my doctor for 2 days about “the shot” and been morally wrong and checking my hormone levels (25 then dropped to 11 in two days) she told me we could wait out . I’m still in danger of hemorraging, but I know @ that point I will have to go to the ER, praying for God’s will to be done, if that happens they would have to cut my tube and ovary, where the baby is actually implanted. For those outhere going through this situation,don’t let your doctor intimidate you and force to take medication that can directly kill your baby, you have moral options get informed before you decide on your health
    God bless,

  8. I just started dealing w/ this today. I started misscarrying July 4th. My levels went from 130 to 95 to 47. (two day intervals) The bleeding stopped, then started again last night (almost a month later) and they retested my levels, which went up to 95…

    The doctor sent me in for an ultrasound, in which they saw nothing. Not in the tubes, not in the uterus…so my doctor told me that I needed the methotrexate injection. I said no. I can not, CAN NOT get the injection unless I am 100 percent positive it’s needed. Because I can not, CAN NOT live with myself if I get the shot, and then find out that I killed a viable baby…Or even a nonviable baby…doesn’t matter to me…a baby is a baby…
    so..we are just watching me very carefully, and praying very hard…

  9. I received had an ectopic pregnancy that was diagnosed at five weeks. I do not smoke, drink or have an STDs. I knew something was very wrong when I had painful and heavy bleeding and cramping for two weeks that wouldn’t stop. I ended up in the ER the same day I found out I was pregnant and told I should end the pregnancy with methotrexate, a chemotherapy drug. I was given little choice and told I would be playing “Russian Roulette” if I waited over the weekend because my pregnancy hormone level could increase along with the possibility of a rupture. I had a “mass” detected on my ovary that showed up on an ultrasound hours earlier. My forming child didn’t even have a heartbeat yet. The pregnancy had not progressed to this point. I just completed my last of several blood tests and doctor’s appointments on Friday, which indicated my pregnancy hormone levels have returned to less than 1 since receiving methotrexate. It has taken a month to get to this point. I had a regular period on time this week too with no time skipped in between. I only heard one story about an ectopic pregnancy from a friend who almost died from her rupture before having an ectopic pregnancy myself. My friend remembers her life fading before her and her husband remembers her being near death. That was my only knowledge relating to an ectopic pregnancy before I actually had one myself. I do not regret my decision. I was bleeding and bleeding and bleeding before I saw a doctor to find out what happening to me. My life was threatened and this child would not make it anyway

  10. IF you are in real danger of bleeding out, then of course you must save your life. The problem isn’t that there is not a very real danger from ectopic pregnancies. The problem is that they are all treated the same. A placenta previa will also cause you to bleed out and your baby to die….but there’s now a treatment for it that can save both your lives.

    In the case of an ectopic pregnancy, there very well COULD be a treatment that could save many, many lives. For example, carefully making an incision in the fallopian tube to allow the forming amniotic sac to grow in the abdominal cavity could prevent a rupture, and there have been literally HUNDREDS of cases of abdominal pregnancies that have resulting in live babies from the 1800s to the 1930s. Could you imagine how many more could be saved with modern methods? If a woman chose this, the danger to her life would be approximately .5%.

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