What is an ectopic pregnancy?
Normally, the fertilized egg is transported by the cilia (tiny cilia) to the uterus within four to five days. There it nests in the loosened lining of the uterus.
In some women, however, the transfer of the fertilized egg does not work properly – either because adhesions are in the way or because the movement of the fallopian tubes and cilia is not strong enough. The egg then nests directly in the fallopian tube. In very rare cases, the egg can also implant in the abdominal cavity (abdominal pregnancy). In most cases, however, the embryo and placenta detach on their own and pass away. If this does not happen, treatment with medication or surgery is necessary. This is because there is a risk of dangerous complications in the advanced stages of an ectopic pregnancy. It is not possible to move the embryo into the uterus. Experts refer to an ectopic pregnancy as an extrauterine pregnancy (Latin: extra = outside, uterus = womb, graviditas = pregnancy).
Ectopic pregnancy: frequency and age
Gynecologists estimate that around 1 to 2 out of 100 pregnancies occur outside the uterus. However, the number remains imprecise: in many cases, the egg implanted in the fallopian tube passes away after a short time without the woman even noticing the pregnancy. Only through the combination of pregnancy tests (hormone tests) and ultrasound examinations are ectopic pregnancies visible at an early stage. The increase in fertility treatments and operations on the fallopian tubes has also led to an increase in ectopic pregnancies. Women over the age of 35 have a higher risk of an ectopic pregnancy than younger women. In around 95 percent of all cases in which a pregnancy begins outside the uterus, the egg implants in the fallopian tube. Only extremely rarely does it grow in the abdominal cavity (abdomen), in the cervix or in the ovaries.
Ectopic pregnancy: causes and risk factors
There are basically two different factors that can prevent the fertilized egg from reaching the uterus directly: the migration of the fertilized egg can be hindered by adhesions or a lack of activity of the cilia (cilia). Anyone who has already had an ectopic pregnancy is at a significantly higher risk of a recurrence.
Operations pose a risk for ectopic pregnancies
Anyone who has suffered an inflammation of the fallopian tubes or has undergone surgery on the fallopian tubes has a higher risk of developing an ectopic pregnancy. In the very rare cases where a woman becomes pregnant despite sterilization of the fallopian tubes, the risk of an ectopic pregnancy is very high: in around one in three pregnancies despite sterilization, the egg implants there. If a woman becomes pregnant despite having an IUD (intrauterine device), the gynecologist should also check whether the egg is in the uterus. This is because ectopic pregnancies occur in around half of all pregnancies despite the intrauterine device being in place.
Other factors slightly increase the risk of an ectopic pregnancy:
- previous infections of the genital organs (such as gonorrhea or chlamydia)
- previous inflammation of the fallopian tubes (salpingitis)
- Infertility treatment
- Fallopian tubes with congenital anomalies
- Morning after pill
- Tuberculosis
Symptoms: An ectopic pregnancy is difficult to detect
In many cases, women do not notice an ectopic pregnancy at first. All signs point to a completely normal pregnancy: There is no period, the pregnancy test indicates pregnancy. Sometimes this is accompanied by nausea and a feeling of tightness in the chest or slight pain in the lower abdomen. Some women also report light spotting or prolonged periods. It is only when the embryo grows larger that women feel a one-sided pulling or pressure sensation in the abdomen – after all, the fallopian tube does not offer enough space for the growing life. Sometimes this pain radiates into the shoulders. This is often accompanied by circulatory problems, combined with shortness of breath, increased pulse and nausea.
The ectopic pregnancy usually ends on its own within the first three months of pregnancy. This is because the fallopian tube is not designed to nourish an embryo and it does not receive enough nutrients. This causes the placenta and amniotic sac to detach from the wall of the fallopian tube and fall off. This causes bleeding that is comparable to menstruation.
It is dangerous if the wall of the fallopian tube ruptures as a result of the embryo growing or leaving (tubal rupture). Blood then enters the abdominal cavity, often in large quantities. Sudden and very severe abdominal pain usually occurs. In the worst cases, bleeding can lead to circulatory failure or even fainting and life-threatening shock. In this case, a doctor must intervene as soon as possible. In many cases, the woman is unaware of her pregnancy up to this point.
Ectopic pregnancy: Diagnosis by us
We usually carry out an ultrasound scan through the vagina between the ninth and twelfth week of pregnancy. If we do not find an embryo in the uterus, even though a pregnancy test is positive, this is an alarm signal. Sometimes the pregnancy is less advanced than expected and the embryo is too small to be seen. Or there has already been an unnoticed miscarriage. Often, however, we can already see the embryo in the fallopian tube by ultrasound during an examination.
Another indication is the monitoring of the pregnancy hormone hCG in the blood: in a pregnancy outside the womb (extrauterine pregnancy), it rises more slowly than in a normal pregnancy. If the value does not rise adequately within 48 hours, doctors see this as an indication of an extrauterine pregnancy. Of course we also ask about complaints. If you complain of abdominal pain, this may indicate an ectopic pregnancy, but it is not conclusive on its own
Ectopic pregnancy: prevention, early detection, prognosis
An ectopic pregnancy cannot be prevented. However, it makes sense to visit your gynecologist as soon as you know that you are pregnant. Especially if you have already had an ectopic pregnancy, have had surgery on the fallopian tubes or ovaries or have undergone fertility treatment. Then you should have a close examination by us. If you recognize an ectopic pregnancy at an early stage and take countermeasures, there is a good chance that you will subsequently become pregnant again and then properly.
However, the risk of a repeat ectopic pregnancy increases with every ectopic pregnancy that is overcome. We recommend waiting one to three months after an ectopic pregnancy before becoming pregnant again. Good follow-up care by the doctor is also important. An ectopic pregnancy and its complications are often a great emotional burden for those affected. An exchange of experiences in self-help groups or psychological counseling can be helpful here.
Ectopic pregnancy: treatment depending on the risk
If you have no complaints, we will probably recommend that you wait a few days first. In many cases, an ectopic pregnancy ends on its own when the embryo is shed. A medical check-up with ultrasound is essential. If there is pain and/or the ultrasound shows evidence of internal bleeding, surgery is necessary. The appropriate surgical method is finally determined during the examination.
