Come Out, Come Out Wherever You Are: Ectopic Pregnancy

A positive pregnancy test brings with it big-time butterflies, big, bright smiles, and a big bag of unknowns. But very rarely does it bring the big question “Wow, I wonder if this pregnancy is located in the right place.” We all just sort of assume that, when we find out we are pregnant, the pregnancy is within the uterus. Unfortunately, this is not always the case. Pregnancies located outside of the uterus, better known as ectopic pregnancies, are not uncommon (and unfortunately never viable). In fact, about 2% of all pregnancies are located outside of the uterus. Bottom line, ectopic pregnancies are a big deal, and if misdiagnosed, can cause a big problem.

While it’s hard to find anything positive to say about ectopic pregnancies (they are a serious foe for any OB/GYN), the good news is that most ectopic pregnancies pick the same hiding spot…again and again and again! The majority of ectopic pregnancies can be found within the fallopian tubes (about 97%).

The remaining spots where ectopic pregnancies like to hide include the ovaries, the cervix, the abdomen, C-Section scars, or the uterine cornua (the uterine horn). Unfortunately, even when ectopic pregnancies hide in the same place, they are not always immediately visible. When they are small, they can escape even the shrewdest of physicians. It is for this reason that we use both pregnancy levels (hCG), weeks of pregnancy, symptoms (pain and bleeding), and the ultrasound pictures to determine if there is a pregnancy hiding where it shouldn’t be. During this “come out, come out wherever you are” phase, it is important to stay close to home and be in constant communication with your OB/GYN. Keeping us posted will allow for a speedier end to this game of cat and mouse.

Another key player in the ectopic hiding game is knowing who is most likely to have an ectopic. Identifying those at risk allows us to send out the search party early (a.k.a. watch a woman who has risk factors for an ectopic the moment she tests positive for pregnancy). Such risk factors include women who have a history of an ectopic pregnancy, previous surgery on one/both of their tubes, a history of PID, STDs, infertility and/or infertility treatments, smoking, or previous pelvic/abdominal surgery. They serve as hints or flashing red lights for OB/GYNs when patients complain of vaginal bleeding and/or abdominal pain in the first weeks of pregnancy.

Knowing what might be lurking outside of the uterus allows us to keep our eyes open and our minds ready to act. Intervening early in the game (when the ectopic pregnancy is small) can minimize the damage that an ectopic pregnancy can cause.

Once an ectopic pregnancy has been discovered, we move pretty quickly to make sure it doesn’t go back into hiding. We initiate treatment immediately and act fast to put an end to this problem. Treatment can be medical, surgical, or in some cases, simple observation. Which is right for you depends on many factors: a woman’s medical and surgical history, the size of the ectopic pregnancy, the pregnancy hormone level, how far along the pregnancy is, and the symptoms one is feeling. After analyzing these factors, the decision to administer methotrexate (the medical treatment) or undergo a laparoscopy will then be determined.

Make sure you have a thorough discussion with your MD about why he or she has selected the specific treatment plan. Although your pregnancy may be hiding, you should not be kept in the dark about what’s going on inside of your body and why a certain treatment is being used.

Ectopic pregnancies are no joke. If untreated, they can lead to massive bleeding and even death (#1 cause of death in pregnant women in the first trimester). It’s because of this that we OB/GYNs get very worked up over even the possibility of one and will stop at nothing until they are found. We will send blood tests on you every two to three days, bring you in for multiple physical exams, and even ask you to undergo repeat ultrasounds to help us figure out where the pregnancy is and how to make it go away. While the follow up can be annoying, it is essential.

In this game of hide and seek, it’s important that we play together (patient + physician) on the same team. Ultimately, no hiding spot is immune from an ectopic. As a united front, we find it quicker and make sure it doesn’t go back into hiding. So let’s uncover our eyes and start searching!