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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Oh, wow!

I’m trying to wrap my brain around this — a woman goes in for a C-section, and when they cut her open, the doctors discover that her baby wasn’t in her uterus at all! The baby had implanted in her ovary. Here’s the full story. Usually, most babies don’t survive an ectopic pregnancy. “Ectopic” just means that it’s outside of the uterus; the typical ectopic pregnancy implants in the fallopian tubes, but not always. As the baby grows, the fallopian tube bursts, and emergency surgery is required to save the mother’s life. This is why almost all pro-life advocates don’t have a problem with abortion in the case of ectopic pregnancies — the likelihood that the baby could live is practically zero, while the likelihood that the mother will die is quite high. It’s not 100%, though. If the implantation happens in the fallopian tube, and the baby manages to grow in the uterus or in the abdominal cavity (as opposed to within the tube itself), then it is possible for the baby to survive. Still, it’s something that should only be attempted with close medical supervision. But here’s something that threw me for a loop — the woman had had an ultrasound midway through her pregnancy, and the ultrasound didn’t pick up that the baby wasn’t even in her uterus.

My thanks to Real Choice for the link to the story.

It reminds me of another story I saw on TV several years ago (I think it was Discovery Health, and the woman was British). She knew she was having twins, and then a late ultrasound discovered a third baby outside her uterus in her abdomen. Because of some complications or high risk of complications, they delivered the babies by C-section at 7 months of gestation, and all survived. They have a name for that condition — when a woman has an intrauterine and and extrauterine pregnancy — heterotopic.

Just thought y’all might like that story.

Update! — I was able to find the story about the ectopic triplet with intra-uterine twins.

DES update

This is a letter I just wrote the the CDC DES update page:

To whom it may concern,
I would like for the government to look into and admit that DES was prescribed by some doctors even after they were told to stop prescribing it. I was born in 1977 and have a cockscomb cervix, which is an evident marker of DES exposure. What I’ve read in the past few days about DES makes me *sick*! There is no other way to describe this pit in my stomach, when I realize that I was given a drug as a fetus that caused my cervix to develop abnormally, and my mom’s doctor ought to have known that it caused reproductive disorders.
I cannot be the only post-1971 victim of this drug. People like me–and all others who have reproductive disorders that may possibly be caused by DES exposure–need to be informed that the 1971 ruling was simply a warning, and not an outright ban. DES was not pulled from the market. In fact, when I was a pharmacy tech about 8 years ago, we used DES (the pharmacist had to compound it, and wouldn’t let any of us techs who were all female even touch the powder) for an elderly man in the nursing home who had a specific type of cancer.
We, and all my DES sisters and brothers, need to know that they may have been affected. Doctors need to know that post-1971 babies can be DES sons and daughters as well. Women need to know that their problems with infertility, miscarriage, stillbirth, and preterm birth may be related to DES, and not “just one of those things.” Even more, it needs to be publicly proclaimed because DES exposure increases the likelihood of certain types of cancer. By not telling the full truth, women supposedly younger than 36 or so will not know that they too may be affected, and that they need more careful gynecological care. By not doing so, our lives may be at risk.
Thank you for your time and attention.

You are not “too young” to be a DES daughter!