Updated: Jun 2, 2020
An ectopic pregnancy occurs when the fertilized egg decides to implant anywhere other than in the uterus where it's supposed to go.
In a normal pregnancy, an egg and sperm meet in the fallopian tube, and that's where the sperm fertilizes the egg. The fertilized egg then takes a few days to travel down to the uterus and implant in the wall of the uterus, where it continues to grow into a full-term baby.
An ectopic pregnancy is when that embryo decides to implant anywhere other than in the uterus where it's supposed to go.
Most commonly, an ectopic pregnancy just decides to stay put in the tube and grow there instead.
There are some other weird places where an ectopic pregnancy can occur, such as on an ovary, or in the abdomen, or in the cervix, but the fallopian tubes are by far the most common.
An ectopic pregnancy in the fallopian tube, can also be called a "tubal pregnancy."
Obviously, there isn't enough room in that tube to hold a baby. In fact after about 2 weeks, that embryo is now too big for the tube.
How do I know if I have an ectopic pregnancy?
A woman with an ectopic pregnancy might first experience just some light bleeding.
Then she will start having pain in that tube, getting worse and worse over time as that tube stretches out.
If this is caught early, it can be treated with medication.
Often a woman with an ectopic pregnancy will present to an ER with bleeding and abdominal pain. Her urine pregnancy test will be positive but we won't see a pregnancy in the uterus on the ultrasound. It can be hard to see the tubal pregnancy itself on the ultrasound, but based on the pregnancy hormone levels, we know when we should see one.
If not caught early, eventually that tube will burst and she will start bleeding into her abdomen. This is a life-threatening emergency.
Once pain is severe - or certainly with internal bleeding - surgery is required.
Risk factors for an ectopic pregnancy:
A history of a pelvic infection known as PID (pelvic inflammatory disease)
If you have an IUD in place, or had your tubes tied already, and now have a positive pregnancy test, call your OBGYN right away because we would be worried you might have an ectopic pregnancy
Can it happen again?
If you have had an ectopic pregnancy in the past, then we'll want to follow you closely with your next pregnancy. We usually check the pregnancy hormone levels early on to be sure they're increasing the right way, and then we'll do an early ultrasound to see where the embryo implanted.
We can't change the outcome - we can't make an ectopic go to the uterus, nor can we surgically transplant it there - that's impossible - it's never happened - it can't happen. (Obviously we would if we could.)
We only follow you closely with the next pregnancy because the earlier you catch this, the more options you have for treatment and obviously the less risks to your health.
So if you're newly pregnant and having some light bleeding, give your OBGYN's office a call so they can see you sooner and follow you closely.
Bleeding is common and doesn't necessarily mean anything is even wrong, but it is important to diagnose an ectopic pregnancy as soon as possible. We would all rather prevent the 3am visit to the ER and emergent surgery whenever possible.
Most patients who have had an ectopic pregnancy go on to have a successful normal pregnancy or more if they choose to.