What Is 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 implanted in one of the fallopian tubes. As it grows, if it is not diagnosed in time, it can cause the tube to tear or burst. This is called a ruptured ectopic pregnancy and 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, and the pregnant person must be treated to avoid risks and complications, such as rupture and hemmorraging, that can be life-threatening.

Symptoms of Ruptured Ectopic Pregnancy

If you have an ectopic pregnancy, you may experience the same early pregnancy symptoms as in a typical pregnancy, 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:

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

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

When an ectopic pregnancy causes a rupture, additional symptoms develop. 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)

Causes of Ruptured Ectopic Pregnancy

Certain people may be more at risk than others of experiencing an ectopic pregnancy. Previous 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. Studies show that 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

Diagnosis of Ruptured Ectopic Pregnancy

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

Treatment of Ruptured Ectopic Pregnancy

Unfortunately, ectopic pregnancies are not viable and require treatment to safely remove the embryo from the fallopian tube (or wherever else it has implanted outside of the uterus). Treatment options for ectopic pregnancy include medical management or surgery. Pharmacologic treatment with methotrexate can be used for early ectopic pregnancy when there is no risk of imminent rupture. Surgery is needed if the ectopic pregnancy has ruptured to repair any damage.

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.

Over 95% of ectopic pregnancies occur in the fallopian tubes, and with the growth of the fetus, the pregnancy would 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.

Potential Complications

Possible complications or long-term effects of an ectopic pregnancy depend on many factors. The first concern is bleeding, and pregnant people are at risk of bleeding to death if emergency care is not sought in a timely matter. Thankfully, with proper treatment, this is rare in the United States.

Around 70% of people who have had ectopic pregnancies are able to become pregnant again (without assistance) even if a fallopian tube is lost through surgery. There is a risk of a recurrent ectopic pregnancy occurring between 10% and 20% of the time. Your physician will probably recommend carefully monitoring you during early pregnancy when you become pregnant again to determine where the embryo has implanted.

A Word From Verywell

It's normal to be saddened and grieve for the loss of an ectopic pregnancy as you would for any form of miscarriage. It is natural to feel shocked, angry, or guilty 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.