What To Know About Ruptured Ectopic Pregnancy

An ectopic pregnancy is a medical emergency in which a fertilized egg implants itself outside the uterus, most commonly in one of the fallopian tubes. As the embryo grows, it can cause the tube to tear or burst if it is not diagnosed and treated in time. This is called a ruptured ectopic pregnancy, and it results in dangerous internal bleeding.

An ectopic pregnancy occurs in roughly 1 in 100 pregnancies. It is important to know that an ectopic pregnancy is not viable, meaning that it cannot develop into a healthy pregnancy or baby, and the pregnant person must be treated to avoid potentially life-threatening complications. Here's what pregnant people should know about ruptured ectopic pregnancy.

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. Signs that the pregnancy is ectopic most often develop six to eight weeks after your last menstrual period (LMP) 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 and brought to a health care provider's attention, an ectopic pregnancy can most often 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, you may experience other 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)

If you are in early pregnancy and notice that you have any signs of ectopic pregnancy at all, ruptured or not, see a health care provider 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.

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. 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 (only applies to people 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

Ectopic pregnancies are not viable and require treatment to safely remove the embryo from the fallopian tube (or wherever it has implanted outside of the uterus). 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.

Treatment options for ectopic pregnancy include medical management or surgery, and rarely can a tubal pregnancy get resolved on its own. Medical management can only 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 surgical treatment, the embryo will be removed, and in some cases, the fallopian tube must be removed as well. In cases of a ruptured ectopic pregnancy where a lot of blood has been lost, blood transfusion may be necessary. Emergency treatment may also require initial stabilization with oxygen, fluids, and elevating the legs above the level of the heart.

Potential Complications

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

It's also normal to be saddened and grieve the loss of an ectopic pregnancy as you would any form of miscarriage. It is natural to feel shocked, angry, or guilty, especially if you have been trying to conceive. It's also OK to feel fine. Reach out to your family and friends for emotional support if you need it. Professional counseling can also be helpful.

Around 70% of people who have had ectopic pregnancies can 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. If you conceive again, your prenatal health care provider will probably recommend carefully monitoring during early pregnancy to confirm where the embryo has implanted.