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A dangerous form of pregnancy that develops and grows before the fertilized egg reaches the uterus.
This article is pending medical review.
Written by Julian Zeegers, Alizeh Ahsan, and Sophie Oppelt
Reviewed by Britte Megens and Sophie Oppelt
Edited by Juliëtte Gossens
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What is ectopic pregnancy?
Normally, implantation of the embryo takes place inside the uterus. An ectopic pregnancy is characterized by the implantation and development of the embryo outside of the uterus. This can occur, for instance, in the fallopian tube or in extreme cases, even the ovaries. A considerable number of US pregnancies are ectopic - up to 2% (1). Ectopic pregnancies greatly endanger the prospective parent as there is a large risk for organ rupture and bleeding events, which can be fatal (2). Ectopic pregnancies account for 6% of pregnant people’s deaths in the United States (1). Early testing and identification is therefore vital in combatting these unnecessary fatalities.
What are symptoms of ectopic pregnancy?
Even though an ectopic pregnancy is never a viable pregnancy, not all ectopic pregnancies cause symptoms. The ones that don’t are often diagnosed anyway by your healthcare professional when you come in for a check-up. If you do have symptoms, they will usually appear between the 4th and 12th week of pregnancy (5). These signs include pain the lower part of your belly (usually on one side), bleeding or dark discharge, and discomfort or pain when going to the toilet (5). Sometimes, people with ectopic pregnancy have pain over the tip of the shoulder (where the shoulder ends and the arm begins) (5).
It can be very difficult to differentiate between normal pregnancy symptoms and ectopic pregnancy symptoms, but if you’re experiencing the above symptoms, you should discuss this with your doctor or midwife as soon as possible. We emphasize this because an ectopic pregnancy can be fatal if not diagnosed and treated in time. Additional symptoms you can look out for include feeling dizzy, becoming pale, and experiencing extreme pain. These symptoms might indicate a rupture of the fallopian tube because the pregnancy has grown too big inside it (5, 6). This happens only rarely and can be treated if caught early, which is why it’s good to alert your doctor when you’ve noticed any of these symptoms. If you’re suddenly feeling very ill or weak, or are suddenly in a lot of pain, call the emergency number in your country for an ambulance.
How is an ectopic pregnancy diagnosed?
The standard testing method for ectopic pregnancy is ultrasound analysis (1, 3). During the first ultrasound assessment, doctors investigate whether an embryo is indeed present, and whether it is located inside the uterus or at an unfavorable location elsewhere. Furthermore, doctors can detect further abnormalities of the uterus and other parts of the reproductive system.
Sometimes, the location of the pregnancy cannot be identified via ultrasound only. A commonly performed test to verify the assumption of an ectopic pregnancy is the β human chorionic gonadotropin (β-hCG) measurement. β-hCG is a hormone that is detectable in blood in early pregnancy. A single measurement of the concentration of β-hCG is already used in the clinic to confirm a pregnancy: this is a regular pregnancy test. However, serial measurements of this hormone can additionally give information about the viability of the embryo. During a healthy pregnancy, the concentration of β-hCG doubles approximately every 48 hours. When a rise in the β-hCG concentration over 48 hours does not reach 50%, or a plateau of the β-hCG concentration is observed within this timeframe, a nonviable pregnancy is assumed. This increases the likelihood of an ectopic pregnancy (4).
A further option for the doctor to identify ectopic pregnancy growth is to perform a laparoscopy. This is a surgical procedure in which an optic instrument enters the abdominal cavity to visualize local structures. Surgical procedures are only performed when there is a large suspicion of an ectopic pregnancy, since surgeries and the accompanying general anesthesia always come with risks, which should be avoided if not necessary. A major advantage of surgical confirmation is the possibility for doctors to immediately intervene when an ectopic pregnancy is detected (2).
Scibetta EW, Han CS. Ultrasound in Early Pregnancy: Viability, Unknown Locations, and Ectopic Pregnancies. Obstet Gynecol Clin North Am. 2019;46(4):783-95. DOI: 10.1016/j.ogc.2019.07.013
Carusi D. Pregnancy of unknown location: Evaluation and management. Semin Perinatol. 2019;43(2):95-100. DOI: 10.1053/j.semperi.2018.12.006
Condous G. The management of early pregnancy complications. Best Pract Res Clin Obstet Gynaecol. 2004;18(1):37-57. DOI: 10.1016/j.bpobgyn.2003.09.011
Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005;173(8):905-12. DOI: 10.1503/cmaj.050222
NHS. Ectopic pregnancy. Available from: https://www.nhs.uk/conditions/ectopic-pregnancy/ [Accessed July 8th, 2022]
Kumar V, Abbas AK, Aster JC (eds.). Robbins and Cotran Pathologic Basis of Disease. Philapdelphia, USA: Elsevier Saunders; 2015.
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