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The silent loss

  • PHOTO BY METROGRAPHICS Ectopic pregnancies are the leading cause of maternal death in the United States. Knowing the signs may save your life.
    PHOTO BY METROGRAPHICS Ectopic pregnancies are the leading cause of maternal death in the United States. Knowing the signs may save your life.
Published March 07. 2014 05:00PM

Ectopic pregnancies are the leading cause of maternal death in the United States.

Many women will never know the pain and sadness associated with this early complication of pregnancy, and will go on to carry and deliver a healthy baby.

But for the one woman out of every 50 who experience an ectopic pregnancy, knowing the signs and seeking medical attention early will save your life, and your chances of becoming a mother.

What is an ectopic


Dr. Alexandria J. George, who specializes in obstetrics and gynecology at OBGYN Associates of the Lehigh Valley and Carbon County, explained that an ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, such as in the fallopian tube, ovary or abdomen.

She said that most diagnosed ectopic pregnancies are in the fallopian tube.

Women who have had surgery in the pelvic area are at greater risk because scarring may cause issues for implantation, but that is not always the case.

George said that sometimes, the woman's fallopian tube may be misshapen or the ectopic pregnancy is strictly a fluke.

She added that the medical world has seen an increase in this type of pregnancy over the past few years because reproductive technologies have advanced, and more women are trying to get pregnant using fertility treatments.

How is it treated?

Once a pregnant woman begins to experience symptoms, which can include bleeding or pain in one side of the abdomen, they should call their doctor immediately.

"You never know what it could be," George said, adding that early detection is key.

Doctors will take blood work to monitor beta hCG (human chorionic gonadotropin) levels, a hormone that a woman's body produces when she is pregnant. Normal pregnancies see a steady rise in hCG levels, but in ectopic cases, George said, the levels will be abnormal.

In addition, an ultrasound may be done to see if the pregnancy can be located. In early pregnancies, it may be difficult to diagnose an ectopic pregnancy because of the size of the egg, which at five weeks, is about the size of a sesame seed.

Once a diagnosis is made, and the pregnancy has not begun to rupture, the doctor will prescribe Methotrexate to prevent it from developing any further. If it has begun to rupture, the doctor will perform abdominal surgery to remove it and any damaged tissue or reproductive organs.

Associated risks

Dr. George said there are many risks to a woman if she does not seek medical treatment immediately once symptoms begin.

They include the possibility of internal hemorrhaging if the pregnancy ruptures, severe anemia and even death.

"Contacting your doctor early puts you in a position where we may be able to save the (fallopian) tube if there is no tubal rupture," she said. "If you don't know what's going on, it is important to call your provider and get checked.

"In most times, women are pretty resilient," George continued. "It's amazing how much blood they can lose before you see it in tests. You can't assume you will be OK if you don't get help though. If you are bleeding, get to the emergency room as soon as possible, because we can check everything and do what needs to be done to save your life."

Future risks

Women who experience an ectopic pregnancy have a higher risk of having a second ectopic pregnancy, George explained.

According to the American Society for Reproductive Medicine, women who had one ectopic pregnancy have a 10 to 15 percent chance of having another ectopic pregnancy. In addition, those same women have a 60 percent chance of giving birth to a baby in the future.

To help cut down on the risks and give women a better chance at becoming a mother after an ectopic pregnancy, doctors recommend getting screened to make sure the fallopian tubes are open, as well as seeing a fertility specialist, who can give other options to increase the chance of a successful pregnancy.

Other early pregnancy


In addition to ectopic pregnancies, many women fear having a miscarriage.

A miscarriage is the loss of a pregnancy before 20 weeks of gestation and is the most common type of pregnancy loss, according to the American Pregnancy Association.

George said that the majority of miscarriages occur because of a chromosomal abnormality, but that isn't the only reason. Other reasons include hormonal problems, maternal health problems, lifestyle choices, a woman's age or incomplete implantation of the egg in the uterine lining.

Oftentimes, women who are experiencing a miscarriage begin bleeding and have abdominal cramping, almost as if it was a period, but heavier.

If this occurs, they should go to the emergency room, where doctors will do an ultrasound and blood work.

In the case of miscarriages, hCG levels will begin to decrease.

Sometimes the person may be able to pass the pregnancy on their own; while other times they will require dilation and curettage, commonly referred to as a D&C, to remove the tissue from the uterus.

George explained that if a woman is experiencing a miscarriage or ectopic symptoms, the pregnancy cannot be saved and the first priority becomes the mother's life.

She added that there is a risk of maternal death with miscarriages as well, mainly because of hemorrhaging.

"It's very important to call your provider when you find out you are pregnant," George said. "They will tell you what to expect and go through your history."

She noted that sometimes a woman's history will label them as high risk, requiring special attention during the first trimester.

Women should also take a multivitamin that contains folate to help protect the baby as it develops in the first trimester.

"Pregnancy usually is a happy time, but the reality is bad stuff can happen, too," George said. "I want women to get in to see their doctor as soon as possible to avoid any complications or problems."

Know the signs

You've taken a pregnancy test that confirmed you are pregnant.

Then you experience vaginal bleeding and have sharp pains in your abdomen.

You may be having complications, such as an ectopic pregnancy or miscarriage.

If you experience the following symptoms, contact your doctor immediately or go to the emergency room.

Signs something is wrong

• Abdominal pain and cramping

• Abnormal vaginal bleeding that is either heavy or light and spotty

• Weakness or dizziness to the point where you feel like you are going to pass out

• Back pain

• Loss of pregnancy symptoms

• White or pink mucus

Symptoms an ectopic pregnancy ruptured

• Low blood pressure

• Weak or rapid pulse

• Pale skin

• Confusion

• Nausea

• Vomiting

• Fainting

• Intense pressure in the rectum

• Pain in the shoulders

• Sharp, sudden severe pain in the lower abdomen

Information compiled from MedlinePlus, WebMD, the American Pregnancy Association and American Family Physician.

Are you at risk?

There are risks with all pregnancies, but some women are more at risk of either miscarrying or having an ectopic pregnancy.

Who is at risk for an ectopic pregnancy?

• Women over the age of 35

• Women who smoke

• Women who got pregnant while an intrauterine device was in place

• Women who had surgery to have their tubes tied or to reverse tubal sterilization

• Women who had many sexual partners

• Women who underwent fertility treatments

• Women who were exposed to the chemical DES, which was a drug to prevent miscarriages and premature delivery in the mid-1900s before birth. DES was found to cause other medical problems in children.

Causes of an ectopic pregnancy

• Birth defects in the fallopian tubes

• Scarring from a ruptured appendix

• Endometriosis

• Previous ectopic pregnancy

• Scarring from infections of the female organs such as pelvic inflammatory disease, chlamydia or gonorrhea.

Who is at risk for a miscarriage

All women could be at risk but age increases the chances of miscarrying.

• 12 percent of women in their 20s

• 25 percent of women in their late 30s to 40.

Causes of a miscarriage

Even though the causes of a miscarriage are not fully understood, here are some underlying issues that could increase a woman's risk of miscarrying.

• Chromosomal abnormalities in the fetus

• Infection

• Environmental or workplace hazards such as toxic agents

• Hormonal problems

• Uterine abnormalities

• Incompetent cervix

• Lifestyle smoking, drinking or illegal drug use

• Immune system disorders

• Kidney, thyroid or congenital heart disease

• Uncontrolled diabetes

• Some medications such as Accutane

• Severe malnutrition

Information compiled from WebMD, MedlinePlus, American Family Physician, the American Society for Reproductive Medicine and the Mayo Clinic.

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