Signs of a Ruptured Ectopic Pregnancy

An ectopic pregnancy is a medical emergency in which a fertilized egg implants itself outside the uterus. Usually, an ectopic pregnancy is situated in one of the fallopian tubes. As it grows, it can cause the tube to tear or burst. This results in dangerous internal bleeding.

An ectopic pregnancy occurs in roughly one in 100 pregnancies. It is important to know that an ectopic pregnancy is not able to develop into a healthy pregnancy or baby. The mother must be treated to avoid risks and complications, such as rupture, that can be life-threatening.

If you have an ectopic pregnancy, you may have the same symptoms as for any early pregnancy at first, such as nausea, tiredness, and breast tenderness. Additional signs that the pregnancy is ectopic most often develop six to eight weeks after your last normal menstrual period but can occur throughout the first trimester. These symptoms include:

• Pain during intercourse
• Irregular vaginal bleeding or spotting
• Cramping or pain on one side, or in the lower abdomen
• Rapid heartbeat

If these symptoms are recognized, most often an ectopic pregnancy can be diagnosed before it ruptures. However, more than 50% of women do not have any of these symptoms before an ectopic pregnancy ruptures.

When an ectopic pregnancy causes a rupture, there are additional symptoms. Any of the following warrant an immediate visit to the emergency room:

• Sudden, severe abdominal or pelvic pain
• Dizziness or fainting
• Pain in the lower back
• Pain in the shoulders (due to leakage of blood into the abdomen affecting the diaphragm)

Certain people may be more at risk than others of experiencing an ectopic pregnancy. Damage to the fallopian tubes is thought to be the cause of most ectopic pregnancies. Scarring in the tube prevents the normal passage of the fertilized egg through the tube and into the uterus where a healthy pregnancy takes place.

The risk of ectopic pregnancy is greater in people who:

• Had treatments for infertility
• Had a previous ectopic pregnancy
• Had previous tubal surgery
• Had a tubal ligation
• Have tubal problems or diseases
• Were exposed in utero to diethylstilbestrol (DES; only applies to women born in 1971 or earlier, as that is when the drug was taken off the market)
• Became pregnant while using an intrauterine device (IUD)
• Have a history of a sexually transmitted infection (STI)
• Have had a ruptured appendix
• Have a history of pelvic inflammatory disease (PID)
• Have scarring from endometriosis
• Have multiple sexual partners

Tests to identify an ectopic pregnancy, whether ruptured or not, may include:

• Pregnancy test
• Ultrasound
• Test of specific levels of pregnancy hormones in the bloodstream
• A sample of uterine tissue taken through a procedure known as dilation and curettage (D&C)
• Laparoscopic surgery to examine the inside of the abdomen

Almost all ectopic pregnancies will require treatment. Treatment options for ectopic pregnancy currently include medical management or surgery. Pharmacologic treatment with methotrexate can be used in an early ectopic pregnancy when there is no risk of imminent rupture. Surgery is needed if the ectopic pregnancy has ruptured.

With surgery, either only the pregnancy is removed from the tube or the entire tube is removed. In ruptured ectopic pregnancy cases where a lot of blood has been lost, you may also require a blood transfusion. Emergency treatment may require initial stabilization with oxygen, fluids, and elevating the legs above the level of the heart.

Women often ask, "Can the baby in an ectopic pregnancy ever be saved?" Sadly, the answer is almost always no—at least with current technology. Over 95 percent of ectopic pregnancies occur in the fallopian tubes, and with the growth of the fetus, the pregnancy would almost invariably rupture without medical intervention. Be sure to have your doctor clearly explain your condition so you understand what has happened. It is natural to grieve the loss of your pregnancy and need emotional support or counseling.

Possible complications or long-term effects of an ectopic pregnancy depend on many factors. The first concern is bleeding, and women may bleed to death if emergency care is not sought in a timely matter. Thankfully, this is very rare in the United States with 21st-century medical care.

Around 70% of women are able to become pregnant again (without assistance) even if a tube is lost through surgery. There is a risk of a recurrent ectopic pregnancy between 10% and 20% of the time. Your physician will probably recommend carefully monitoring you during early pregnancy when you become pregnant again.

You may be saddened and grieve for the loss of an ectopic pregnancy as you would for any form of miscarriage. It is natural to feel shock, anger, or guilt that this has happened to you, especially if you have been trying to conceive. You will face hormonal changes that can intensify your emotions, as well as contribute to fatigue, difficulty sleeping, and trouble concentrating. Reach out to your family and friends for emotional support. Counseling may also help you during this difficult time.