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Pregnancy will always be synonymous with a whirlwind of emotions – joy, fear, stress, excitement, to name a few. And sometimes, heartbreak weasels its way into this momentous time of your life in the form of an ectopic pregnancy. While it’s difficult to talk about, it’s worth arming yourself with the facts about this condition, because ectopic pregnancy is the most common cause of U.S. maternal mortality in the first trimester.
An ectopic pregnancy occurs when a fertilized egg implants outside of the endometrial cavity instead of attaching to the lining of the uterus. In about 90% of cases, the pregnancy forms in one of the fallopian tubes, but it is possible for the embryo to implant in another abnormal area like the ovary, the cervix, or the abdominal cavity.
Unfortunately, ectopic pregnancies are not viable (an embryo cannot survive outside of the uterus), so they are usually treated via either medication or surgery: The drug methotrexate is commonly prescribed to stop the cells from growing, thus ending the pregnancy.
These treatment plans, however, are for when the ectopic pregnancy is discovered and treated early. In some situations, a ruptured ectopic pregnancy can occur. Rescripted spoke with Melissa Montes, M.D., a fertility specialist with Kofinas Fertility Group in New York, who walked us through this frightening complication's risks, symptoms, and treatment.
Understanding ectopic pregnancy
A ruptured ectopic pregnancy is when an embryo growing in the fallopian tube causes the tube to burst. This in turn causes “internal bleeding, and can be life-threatening if not treated immediately,” says Dr. Montes. Fortunately, death by ectopic pregnancy is still a rare occurrence in the United States, with less than 50 people dying from this condition per year.
With the overturning of Roe v. Wade in 2022, however, ectopic pregnancy treatment can get complicated in states with abortion bans. The American College of Obstetricians and Gynecologists (ACOG) says that abortion bans, despite legislative language allowing exceptions for life-saving treatments “can generate confusion for patients and health care professionals and can result in delays to treatment.”
This is precisely what happened to a Texas woman named Kelsie Norris-De La Cruz, who was initially denied treatment for her ectopic pregnancy at her local hospital. By the time she received emergency surgery elsewhere, Norris-De La Cruz was already in the early stages of a ruptured ectopic pregnancy.
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Norris-De La Cruz survived, but her harrowing ordeal necessitates an increased awareness of ectopic pregnancies and the threat they pose if they are not treated promptly.
Symptoms of a ruptured ectopic pregnancy
It’s critical to visit your medical provider regularly for ultrasounds once your pregnancy is confirmed because symptoms of ectopic pregnancy aren’t always noticeable. “If a doctor is monitoring an early pregnancy he/she may be alerted if the pregnancy hormone is not rising appropriately and a pregnancy is not visible in the uterine cavity,” says Dr. Montes. This monitoring would allow for early detection of the ectopic pregnancy. Symptoms only become more apparent when the tube ruptures: “The patient may feel severe pelvic pain and cramping,” says Dr. Montes. “If there is massive blood loss they would feel faint and lightheaded.”
Treatment for a ruptured ectopic pregnancy
While it is possible to treat an early-diagnosed, not-ruptured ectopic pregnancy with medication, Dr. Montes says a ruptured ectopic pregnancy “must be treated with emergency surgery. Typically, a laparoscopy is performed to remove the ruptured fallopian tube.”
Trying to conceive after a ruptured ectopic pregnancy
The good news is it is possible to conceive again after you’ve recovered from a ruptured ectopic pregnancy, says Dr. Montes. Pregnancy can occur “even if one of the patient’s fallopian tubes was removed, as long as the remaining fallopian tube is functional,” she explains.
Still, it’s a good idea to consult with your medical provider before TTC again to discuss options and risk factors: Dr. Montes says IVF can be an option for patients with “impaired fallopian tubes” or a “medical history that puts her at great risk for ectopic pregnancy.”
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It’s also important to remember that “if the patient has a history of an ectopic pregnancy she is at an increased risk of having another ectopic pregnancy,” says Dr. Montes.
Are there risk factors for an ectopic pregnancy?
If you have a condition that can cause scarring or impaired fallopian tubes, then you’re at risk of ectopic pregnancy says Dr. Montes. Speak with your medical provider about your options – preferably before trying to conceive – if you are dealing with any of the following: untreated sexually transmitted disease, a history of pelvic inflammatory disease (PID), the presence of a hydrosalpinx, prior pelvic surgery, or severe endometriosis.
Otherwise, there is no way to prevent an ectopic pregnancy, so Dr. Montes advises using birth control if you are not TTC.
Support after an ectopic pregnancy
Any form of ectopic pregnancy, whether it results in a rupture or not, can be a traumatic experience, because it involves pregnancy loss. Even if you hope to conceive again, you must take care of yourself first. This includes following all of your doctor’s physical recovery recommendations, as well as, if necessary, seeking out mental health support from either a professional or from a community of others who have experienced ectopic pregnancy. Recovering from an ectopic pregnancy means giving yourself grace, and then, when you’re ready, you can speak to your medical provider about trying to conceive again.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.