What Are the Signs of a Ruptured Ectopic Pregnancy?

A ruptured ectopic pregnancy is a medical emergency in which a fertilized egg implants itself outside the uterus where a normal pregnancy gestates. Usually, an ectopic pregnancy is situated in one of the fallopian tubes, and as it grows, it can cause the tube gets to tear or burst. This results in dangerous internal bleeding.

An ectopic pregnancy occurs in roughly 1 in 50 pregnancies. It is important to note that an ectopic pregnancy is not able to develop into a healthy pregnancy or baby, and treating the mother to avoid risks and complications is paramount.

Identifying the presence of an ectopic pregnancy before it ruptures is the goal. Signs of an ectopic pregnancy include some of the same symptoms as early pregnancy, such as nausea, tiredness and breast tenderness. However, there are additional signs that may indicate the pregnancy is ectopic, including:

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

When an ectopic pregnancy causes a rupture, there are additional symptoms. Over 50 percent of women do not have any of the above symptoms before an ectopic pregnancy ruptures. 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 because 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.

Damage to the fallopian tubes is more common in women over the age of 35 and among women who have these characteristics:

• Had treatments for infertility
• Had a previous ectopic pregnancy
• Had previous tubal surgery
• Had a tubal ligation
• Tubal problems or diseases
• Was 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)
• A history of a sexually transmitted infection (STI)
• A history of a ruptured appendix
• A history of pelvic inflammatory disease (PID)
• Has scarring from endometriosis
• Had multiple sexual partners

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

• A pregnancy test
• An ultrasound
• A test of specific levels of pregnancy hormones in the bloodstream
• Taking a sample of uterine tissue 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, but medical treatment is only used very early on when there is no risk of imminent rupture.

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, the patient may also require a blood transfusion. Emergency treatment may also 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 the technology we currently have. Over 95 percent of ectopic pregnancies occur in the fallopian tubes, and with the growth of the fetus, the pregnancy will almost invariably rupture.

If you are in early pregnancy and notice that you have any signs of ectopic pregnancy at all, ruptured or not, it is a wise move to call your doctor for a checkup. Be aware that a ruptured ectopic pregnancy is a true medical emergency. When in doubt about whether this is what is going on, go to the emergency room right away.

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 in the 21st century with good medical care

Around 70 percent 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 occurring, which is described as between 10 and 20 percent. Your physician will probably recommend carefully monitoring you during early pregnancy when you become pregnant again.

Sources:

Kumar V, Gupta J. Tubal Ectopic Pregnancy. BMJ Clinical Evidence. 2015. 16:2015.

Melcer Y, Maymon R, Vaknin Z, Pansky M, Mendlovic S, Barel O, Smorgick N. Primary Ovarian Ectopic Pregnancy: Still a Medical Challenge. Journal of Reproductive Medicine. 2016. 61(1-2):58-62.