Though you have probably heard about ectopic pregnancies, you probably don't know very much about them — like that they are deeply serious and not as rare as you might think. The phenomenon — which occurs when a fertilized egg decides to implant itself outside of the womb (usually in the fallopian tubes, though in exceptional cases it can implant elsewhere in the abdomen) and grow there — affects one in 80 pregnancies, according to the Ectopic Pregnancy Trust; it's not exactly common, but it's also not totally out of the blue. So how do you know if you're having an ectopic pregnancy? It turns out that, unfortunately, there isn't exactly a blueprint we can go by for every single case. But there are certain signs that may seriously help you out if you recognize them.
Ectopic means "in an abnormal position," and in an ectopic pregnancy, the causes of the egg's misplaced implantation aren't always clear to medical professionals. Sometimes it's due to scarring in the fallopian tubes, something abnormal in the shape of the reproductive system, or previous infections; and certain things, like smoking and pelvic inflammatory disease, are known to cause higher rates of ectopic pregnancies, likely due to related pelvic damage. But we're still not completely clear about why it happens in all cases.
The key thing to know about ectopic pregnancies, beyond their symptoms, is how early in pregnancy they turn up: generally between the 4th and 12th week of pregnancy, which means you may not even know you're pregnant at the time. Ectopic pregnancies will likely, but not always, cause positive pregnancy tests.
Here are five signs that, individually or together, may indicate an ectopic pregnancy. If you're having any of them, get to a GP or a hospital immediately.
1. Shoulder Tip Pain
The reason that ectopic pregnancies create a medical emergency isn't necessarily the placement of the egg outside the uterus; it's what happens as it grows — most often, particularly with eggs that have implanted in the fallopian tubes, the fertilized egg can cause ruptures where they grow and possibly serious internal bleeding. That's what makes this so dangerous, and what leads to the shoulder-tip sign.
Pain at the very tip of the shoulder, where the shoulder ends and the arm begins, is a signal of specific internal bleeding. As the rupture bleeds into the abdomen, it creates pressure on the diaphragm, which in turn stresses nerves that run into the shoulder. This pain may intensify if you lie down, and is, in its weirdness, a pretty reliable sign that something is badly wrong.
2. Light Brown Discharge
Discharge can differ radically between ectopic pregnancies; it depends on where the egg has implanted and what it's done to the area around it. You could get anything from no discharge to heavy flow, but the most common reported symptom is brownish discharge, clearly containing old blood but not in itself a period. This is a signal of internal bleeding or rupture and needs to be noted.
The wide variety of ectopic implantation locations can cause a lot of variation in symptoms. Eggs can turn up in the fallopian tubes, the cervix, the ovaries, within an old Caesarian scar, or elsewhere in the abdomen. Depending on their location and other factors, the ectopic pregnancy can "dissolve" back into the body, be miscarried and require surgical intervention to remove, or keep growing for longer periods before causing issues. There's a lot of different possibilities in play here, so if you experience any symptoms, it is incredibly important to talk to a doctor.
3. Pain On One Side Of The Abdomen
As is probably unsurprising in the case of an egg growing somewhere it shouldn't, pain is a fairly common symptom in ectopic pregnancies — particularly in situations where the egg has caused damage and bleeding. In tubal ectopic pregnancies, in which the egg lodges one of the fallopian tubes, the pain will be centered on one side of the abdomen, depending on which tube has an egg implanted within it. Interestingly, women who manage to get pregnant while they're using an IUD or are on the mini-pill (which is progesterone-only) are more likely to have ectopic pregnancies, as both methods make it actively difficult for fertilized eggs to implant in the uterus.
4. Bowel Problems
In one of the more confusing aspects of ectopic pregnancies, they can present symptoms similar to gastroenteritis: a tender abdomen, vomiting, and either constipation or diarrhea. (Hence why things like the shoulder tip test are essential.)
Any bowel issues that come from an ectopic pregnancy aren't because the egg has itself lodged in the bowel; rest assured that that's essentially impossible. Rather, it's most often a response to internal bleeding, pressure or rupturing in the abdomen. If you do suspect an ectopic pregnancy, note your bladder and bowel responses since pain or symptoms began, and mention them to your doctor.
5. Serious Pain And Collapse
Fallopian tube ruptures are deeply unpleasant. The fallopian tubes don't have a lot of internal stretch and an implanted egg that doesn't dissolve is likely to split them, which counts as a medical emergency and will require immediate surgery to resolve. The accompanying pain and internal blood loss will likely be severe, which means you may well faint. Charming, right? However, this isn't inevitable, and if you do need surgery, they won't remove everything in your reproductive system, and will likely only focus on removing the part of the tube with the egg in it.
But it may not get to that point. If you are diagnosed with an ectopic pregnancy, which usually happens with an ultrasound and blood tests, you may be able to be able to stop the egg's growth with a dose of methotrexate, a cancer and psoriasis drug that interferes with cell growth. People who are able to take this generally don't have to get surgery in addition — but methotrexate (which would stop the egg growing in the fallopian tube by preventing cells from dividing, prompting the egg's slow reabsorption) can only be used if it is very early in the pregnancy, the tubes aren't ruptured, and you go through very intensive monitoring while taking it. It's considered better than surgery with regard to being able to get pregnant again in the future, but once you get diagnosed, your doctors should walk you through all your options, from keyhole procedures to doing a "wait and see" approach, in case the ectopic pregnancy resolves on its own. Just remember: it may be scary, but you have options.
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