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.
Symptoms
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)
Causes
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:
Had treatments for infertility
Had a previous ectopic pregnancy
Had previous tubal surgery
Had a tubal ligation
Tubal problems or diseases
Been exposed to DES (DES or diethylstilbestrol was a medication used to prevent miscarriage in women at risk. It was taken off the market in 1971 when it was found that women whose mothers were treated with the drug had an elevated risk of cancer of the vagina or cervix. Since it was removed from the mother, it is only women now in their 40's who would be at risk)
Become 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)
Scarring from endometriosis
Multiple sexual partners
Diagnosis
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, or D&C
Laparoscopic surgery to examine the inside of the abdomen
Treatment
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 the pregnancy only 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 elevate 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.
When to Call Your Doctor (or 911)
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—but please be aware that a ruptured ectopic pregnancy is a true medical emergency and not something to be trifled with. When in doubt about whether this is what is going on, please go to the emergency room right away.
Complications
Possible complications or long-term effects of an ectopic pregnancy depend on many factors. Of course, 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., and J. Gupta. Tubal Ectopic Pregnancy. BMJ Clinical Evidence. 2015. 16:2015.
Melcer, Y., Maymon, R., Vaknin, Z., Pansky, M., Mendlovic, S., Barel, O., and N. Smorgick. Primary Ovarian Ectopic Pregnancy: Still a Medical Challenge. Journal of Reproductive Medicine. 2016. 61(1-2):58-62.
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