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What's an ectopic pregnancy?

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Anna asks:

What is ectopic pregnancy? I saw it listed as one of the possible risks with Plan B.

Heather Corinna replies:

An ectopic pregnancy is a pregnancy where an ovum (egg) has been fertilized, but instead of then implanting in the uterus where it needs to in order to develop properly, it instead has implanted somewhere else, most commonly in a fallopian tube, but sometimes in the ovary, cervix or even -- in extremely rare cases -- the stomach. (The word ectopic means "out of place.") Sometimes you might also hear ectopic pregnancy called "tubal pregnancy." It's not common, but does occur in the neighborhood of every two in 100 pregnancies. An ectopic pregnancy is usually identified via a blood test, vaginal exam and/or an ultrasound.

These pregnancies cannot be brought to term, due to the risks to a woman's health and life, and because a fetus needs to be inside the uterus in order to develop properly. An ectopic pregnancy can't somehow be moved to the uterus: it is a pregnancy that will need to be terminated.

Most commonly, the cells of an ectopic pregnancy are removed either with one of the medications used for a medical abortion (also called "the abortion pill" or methotrexate) or via a laproscopic surgery (a minimally invasive surgery done with very small incisions and small tubes through which a tiny camera and the surgical instruments are used to do the surgery). In some cases, more intensive abdominal surgery may be needed, particularly in cases where the pregnancy has gone on for some time and the embryo has managed to continue to grow.

Most of the time, a woman with an ectopic pregnancy will still get a positive result if she takes a home pregnancy test. An HPT doesn't distinguish between a normal pregnancy and an ectopic one: it just tests for the hormones a pregnancy creates. However, sometimes, home pregnancy tests will not detect an ectopic pregnancy, so that's one reason why, if you've been sexually active and have missed a couple periods, but still have a negative HPT result, it's a good idea to check in with your reproductive healthcare provider.

Why does it happen? There are a few common causes.

Women with pelvic inflammatory disease are at a particular risk of ectopic pregnancy, accounting for around half of all cases, and many cases are thought to be due to having had a previous ectopic pregnancy or having had an infection on, or surgery of, the fallopian tubes before. Birth defects and endometriosis are other possible causes. Use of synthetic hormones -- including birth control pills or Plan B -- can pose a higher risk of ectopic pregnancy, as can use of the IUD (pregnancies which occur while women are using IUDs are usually ectopic) or IVF (in vitro fertilization). And sometimes, we just don't know why one has occurred.

Some common symptoms with ectopic pregnancy are typical pregnancy symptoms like missed periods, breast tenderness or nausea. Other symptoms not so typical with normal pregnancies, but which can occur with an ectopic one, are unexplained vaginal bleeding and pain or cramping in the shoulder, lower back, stomach or pelvis. Sometimes, ectopic pregnancies -- particularly if they go undetected and untreated for some time -- will rupture the area where they are, and that can cause shock, fainting or very sharp, severe and sudden abdominal or pelvic pain.

Ectopic pregnancy is one of the many, many reasons that we suggest that women who are planning to become pregnant or have recently become pregnant and have only verified a pregnancy with an HPT be sure to start regular care with an OB/GYN, midwife or other reproductive healthcare provider promptly. Even for women who have become pregnant and are not sure if they want to continue or terminate a pregnancy, getting in to see a healthcare provider to find out if the pregnancy is a healthy one is important when it comes to women's health.

It's also one of the many reasons we strongly advocate for women to be sure to keep current with full STI tests at least yearly, more often if women change partners more frequently than that, because untreated infections can create many health risks, including an increased risk of ectopic pregnancy. The same goes for your partners: remember, one partner's tests can't make do for both partners -- it's really important everyone is getting regularly tested. Because so many ectopic pregnancies are due to complications from sexually transmitted infections, it's also yet another good reason to be consistent about practicing safer sex, including the use of latex barriers (condoms, dental dams, latex gloves) and limiting the number of sexual partners.

Here are a few additional links on related topics:

written 01 Nov 2008 . updated 13 Nov 2008

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