An ectopic pregnancy is a health condition in which an embryo implants and develops outside the of uterus, in areas like the fallopian tubes, ovaries, abdominal cavity, or cervix.

An ectopic pregnancy can occur at week 6 to 8 of pregnancy, and may vary in how it presents. Some women may not notice any symptoms, while others may notice mild symptoms like abnormal vaginal bleeding and mild abdominal pain.

However, in severe cases of ectopic pregnancies, a fallopian tube can rupture and lead to heavy bleeding, intense lower abdominal pain and fainting. In these cases, you should proceed immediately to a hospital for assessment and treatment.

Imagem ilustrativa número 3 — This ectopic pregnancy took place in the right fallopian tube.

Common symptoms

Some early symptoms of an ectopic pregnancy are:

Irregular, watery or dark brown vaginal bleeding
Mild abdominal or lower back pain
Mild cramps only on one side in the lower belly
Lower back pain
Breast sensitivity

A fallopian tube rupture is a serious condition that can cause bleeding, sudden and intense pain in the lower abdomen, shoulder pain, weakness, dizziness and fainting. In this case, you should seek urgent medical attention for prompt treatment.

However, it is important to note that not all women with an ectopic pregnancy experience symptoms. In these cases, it is only discovered during prenatal consultations or tests.

Confirming a diagnosis

An ectopic pregnancy is typically discovered during regular prenatal consultations with the obstetrician, who will assess any presenting symptoms as well as the woman's health history.

To confirm a diagnosis, the doctor will order tests such like an hCG blood test, transvaginal ultrasound and diagnostic laparoscopy.

The doctor may also opt to order an MRI to rule out other conditions that can present similarly to ectopic pregnancy, such as uterine fibroids, ovarian torsion, appendicitis, miscarriage and pelvic inflammatory disease.

Possible causes

Ectopic pregnancies occur when an embryo fails to move through the fallopian tube due to damage in this organ.

Factors that can increase the risks for an ectopic pregnancy are:

Previous ectopic pregnancy
Endometriosis
STIs
Fallopian tube surgery
Pelvic inflammatory disease
Infertility
Tumor

Furthermore, women over the age of 35, who smoke, have used an IUD or have had in-vitro fertilization are at an increased risk for an ectopic pregnancy.

Types of ectopic pregnancy

Depending on the location affected, the types of ectopic pregnancy are:

Tubal pregnancy: this is the most common type of ectopic pregnancy, where the embryo attaches itself to the inside of one of the fallopian tubes
Cervical pregnancy: occurs when the embryo develops in the cervix
Caesarean scar pregnancy (CSP): although very rare, the embryo can develop in the scar of a woman's previous cesarean section
Ovarian ectopic pregnancy: occurs when the embryo attaches to the ovaries
Heterotopic pregnancy: occurs when the embryo develops between the uterus and the fallopian tube
Interstitial ectopic pregnancy: occurs when the embryo develops in the part of the tube that passes through the tissue of the uterus

In addition, there is also an abdominal ectopic pregnancy, which happens when the embryo develops in the abdominal cavity or attaches itself to the intestines, urethra or other organ.

Treatment options

Treatment should be directed by an obstetrician and involves medication and surgery.

1. Medicine

Methotrexate, in a single oral dose, is the medication that can be prescribed by the doctor when the embryo does not show cardiac activity, when hCG levels are below 5,000 mIU/mL and if the woman does not present with abdominal pain. The doctor will prescribe this medication if the woman is planning for a pregnancy in the future.

Methotrexate can also be administered via intramuscular injection, and is indicated in cases of ectopic pregnancies that occur in an atypical location.

2. Surgery

Surgery is the most recommended treatment for ectopic pregnancy, and can be performed through laparotomy. It is advised for cases of a fallopian tube rupture with hemodynamic instability, in which the body is unable to maintain a normal blood pressure.

In other cases, laparoscopy is more recommended. It involves a smaller incision than a lapartomay, and therefore is associated with a faster recovery time and shorter hospital stay.

A salpingectomy involves partially or completely removing the fallopian tube, and is indicated in cases of irreparable damage to the fallopian tubes.

Possible complications

The main complication of ectopic pregnancy is heavy bleeding from blood vessel rupture, which can be life-threatening.