Mona is a veteran writer for Pressenza, columnist for Enrich Magazine, and life coach. She holds webinars on writing and emotional health.
After Liya and her husband married, they planned to have children right away. Liya had taken birth control pills for 15 years, before then. Upon stopping, she knew that normally, pregnancy occurs within 1-3 months, or within the year.
But hers was an unusual case. She immediately had horrible headaches and keen exhaustion, which she blamed it on her hormones, presuming her body was adjusting to being off the pill.
Two weeks later, she had a period that refused to go away. She was spotting regularly, which was unusual for her. Neither did her pain and exhaustion cease. A home pregnancy test result was positive, but she had gotten pregnant immediately after she stopped the pill, which was far earlier than the 1-3 month window, and way too soon.
Liya’s doctor gave her a blood test to measure her level of human chorionic gonadotropin (hCG), a pregnancy hormone that is detectable one week after implantation. HCG encircles the embryo and forms the placenta, through which an embryo is nourished and where waste is disposed of.
Liya’s blood test revealed low levels of hCG which is normal at the start of a pregnancy. The hCG levels double every 48 hours, but in Liya’s case, they rose, fell, plateaued, rose, and fell with each blood test taken every two days for two weeks. This is a classic symptom of an ectopic pregnancy.
It's a terrible thing to know your pregnancy won’t thrive, and although she didn’t feel it then, Liya was lucky. Oftentimes an ectopic pregnancy is diagnosed late, between 6-16 weeks. In such cases, there is the danger of a ruptured fallopian tube. The situation could possibly have led to death for Liya if the embryo burst. If she survived, she might lose one fallopian tube, which greatly lessens one’s chance of giving birth in the future.
Ectopic pregnancy defined
Ectopic means “misplaced”. In Liya’s case, her fertilized egg should have traveled from her fallopian tube into her uterus, and attached itself to the uterine wall. Ninety percent of ectopic pregnancies result from a fertilized egg implanting on the fallopian tube, called tubal pregnancies. In rare cases the fertilized egg implants on the cervix or ovary. All of the above are ectopic pregnancies.
The usual causes are:
- Hormonal imbalance
- An abnormally developed fertilized egg
- An impaired or deformed fallopian tube.
It’s impossible for an ectopic pregnancy to complete its term and result in a normal baby. Instead, as the fetus grows it will burst where it’s implanted, risking the loss of a fallopian tube, or worse, risking the mother’s life. To avoid these, a mother should be treated as early as possible once she knows she has an ectopic pregnancy.
Signs of ectopic pregnancy
Early warning signs of an ectopic pregnancy are similar to those of a healthy pregnancy. In fact, a pregnancy test will be positive both for healthy and ectopic pregnancies. Things to look out for are:
- A lapsed menstrual period
- Motion sickness and vomiting
- Tenderness and swelling of the breasts
- Breast soreness that lasts longer than one’s usual premenstrual syndrome
The uterus and fallopian tubes
Specific early warning signs of ectopic pregnancy are:
- Feeling constantly like you want to move your bowels.
- Spotting or light vaginal bleeding outside of your normal period cycle.
- Chronic pain in the pelvis can be dull or sharp.
- Shoulder pain due to bleeding in the fallopian tube area.
Signs of an ectopic pregnancy are determined largely by where the embryo has implanted itself. With growth, the nerves at its location will be irritated, leading to increased blood flow in the injured area. This results in the inflammation of the affected nerves. Other symptoms are:
- Sharp pain on one side of the body, spreads to the other side.
- Worsening pain with movement, exertion, and injury.
- Pain either in the pelvis or the abdomen.
- As the embryo grows, it can rupture the organ that it’s attached to, resulting in heavy internal bleeding and an extreme feeling of lightheadedness. At this point, you are now in a life-threatening situation.
- Other dangerous signs are syncope, shock, weakness, fast breathing, a quick heart rate, anxiety, thirst, and sweating.
What puts a woman at risk of having an ectopic pregnancy?
Some habits and/or incidences that women might experience can make them more likely candidates for ectopic pregnancy. For example:
1. Smoking. Scientists from the University of Michigan noted that smoking raises levels of the protein PROKR1 in the fallopian tubes. High levels of protein PROKR1 inhibits the ability of the fallopian tube’s walls to contract -- a necessary activity to push a fertilized egg to the uterus where it implants safely.
2. Vaping. According to fertilitycenter.com, vaping contains nicotine, just like cigarettes do. Vaping has been shown to affect infertility, and risk higher incidence of an ectopic pregnancy.
3. Pelvic Inflammatory Disease (PID). The incidence of Pelvic Inflammatory Disease (PID) caused by gonorrhea can damage the fallopian tubes, which in the future can cause an ectopic pregnancy.
4. Chlamydia. Previous incidence of chlamydia can lead to an ectopic pregnancy in the future, according to a study by Qingchang Xia, MS, Tianqi Wang, MD, Jin Xian, MS, Jingyan Song, MD, Yan Qiao, MS, Zhenni Mu, MS, Honggen Liu, MS, and Zhengao Sun, PhD. The study was published in the journal, Medicine.
5. Infertility puts a woman at moderate risk of ectopic pregnancy.
6. Choice of birth control. The use of an intrauterine device (IUD) poses the rare possibility of a pregnancy that, if ever, may be an ectopic pregnancy.
7. Tubal ligation. This is an operation where the fallopian tubes are severed and tied, as a form of permanent birth control. In rare incidences, there are ectopic pregnancies, despite tubal ligation.
8. Fertility treatments. Some studies indicate that a woman with a history of in vitro fertilization (IVF), or similar regimens is more at risk of an ectopic pregnancy. Infertility itself may also raise your risk.
9. Incidence of endometriosis. Endometriosis occurs when the tissue that lines the inside of the uterus also spreads outside. When this happens, a fertilized egg may attach outside the uterus, perhaps to the ovaries or another organ.
How is an ectopic pregnancy diagnosed?
To find out if you have an ectopic pregnancy, your doctor will do some of the following:
- Pelvic exam. The doctor will do this to check the size of your uterus and to feel for growths or tenderness in your belly.
- Blood tests to check your hCG levels. After your first blood test, succeeding blood tests every two days should result in doubled levels of hCG. Low and fluctuating levels of hCG suggest an ectopic pregnancy.
Ultrasound. This allows a doctor to see what is inside your uterus. A pregnancy in your uterus can usually be seen six weeks after your last menstrual period. Also, 95% of ectopic pregnancies can be seen with a transvaginal ultrasound. Sometimes, however, the ectopic pregnancy is too small to be detected. In such cases, you will have to have succeeding ultrasounds until the gestation sac is visible.
Laparoscopy. A doctor may see pelvic bleeding, an empty uterine cavity, or abnormal growth on one segment of the uterine cavity via ultrasound. To be certain, however, the doctor may suggest a laparoscopy to directly view the abnormality.
How are ectopic pregnancies treated?
There are three ways that ectopic pregnancies are treated, namely:
1. Expectant management. Oftentimes women with ectopic pregnancies don’t need an operation, especially if the pregnancy is detected early. If your symptoms are very mild and the fetus cannot yet be found, the doctor may monitor you regularly. There is the possibility that the pregnancy will diffuse and terminate on its own, according to NHS, UK. The upside is that you won’t experience side effects. The downside is the very rare risk of rupture, which can split your fallopian tube. With regular monitoring, the doctor should know when more invasive treatment is needed to prevent this from happening. If your doctor opts for expectant management you may experience:
- Vaginal bleeding, which must be managed with sanitary pads, not tampons.
- Stomach pain. You can take paracetamol for the pain.
- Regular blood tests until hCG levels are no longer present.
If hCG levels increase rather than decrease, further treatment will be needed, namely:
2. Medication. Usually, methotrexate injections are used for unstable bleeding. This will inhibit cells from growing, and terminate existing cells. The upside is, there’s no surgery. The downside is, there may be side effects. Also, the doctor will require blood tests afterward to ensure that the medicine worked.
a. Blood tests will be required post methotrexate so the doctor can see if the medicine works. He can then determine whether you need more medication.
3. Laparoscopy. If your ectopic pregnancy was discovered longer than its incidence of a few weeks, surgery is the safest and most effective option. A laparoscopy is the usual surgery. It involves a small cut or cuts in the abdomen through which a thin tube is inserted. The laparoscope is placed into the incision. Once inside, the surgeon can see the abdominal cavity through video monitors in surgery. A laparoscopy enables the doctor to do the same thing he would do in a normal operation, but the incisions are much smaller.
Are There Ways to Prevent an Ectopic Pregnancy?
Losing a pregnancy is always hard, and the pain may still follow you decades after. Because of this, you must allow yourself to grieve. Open yourself to support that is offered to you. Sympathetic people can empathize and help you get through this difficult time.
An ectopic pregnancy makes you prone to possible depression. If it lasts more than two weeks, tell your doctor about it. Talk about your fears and uncertainties. You may be concerned that you’ll never have a normal pregnancy in your life, but that may not be true. Instead, your experience of an ectopic pregnancy tells you that:
- You may have a hard time getting pregnant, but it may not be impossible.
- You are at a higher risk of experiencing another ectopic pregnancy.
If one fine day you discover that you’re pregnant again, tell your doctor that you once had an ectopic pregnancy in the past. Because of this, your doctor will subject you to regular tests that are taken in the first weeks of pregnancy. You will discover one of two things. First, you once again have an ectopic pregnancy. Second, your doctor may confirm that your pregnancy is normal, and that little embryo has successfully clutched onto the lining of your womb.
Note: Originally published in Enrich Magazine, January 2021
Mona Sabalones Gonzalez (author) from Philippines on September 19, 2021:
Thank you Amara, and thank you also for visiting:):):)
Mona Sabalones Gonzalez (author) from Philippines on September 19, 2021:
Oh, I'm very sorry for your aunt. This is a heartbreaking illness especially if you want children. Thankfully, your aunt decided not to risk another ectopic pregnancy. Lives can still be fulfilling without children as long as you have a supportive group of relatives who love you.
Amara from Pakistan on September 19, 2021:
An informative read.
FlourishAnyway from USA on September 18, 2021:
Back in the 1980s, my aunt had two of these and thus never had children.