What is an ectopic pregnancy, and what causes it?

One of the most special periods in a woman’s life is pregnancy. However, not every pregnancy progresses normally and healthily. If the fertilized egg grows outside the uterus and is not treated in time, it can lead to life-threatening risks. More than 90% of all ectopic pregnancies are located in the fallopian tubes [1].

What Is an Ectopic Pregnancy?

Pregnancy begins with the fertilization of the egg. Under normal conditions, the fertilized egg implants in the inner lining of the uterus. In an ectopic pregnancy, however, implantation occurs outside the main cavity of the uterus—most commonly in the fallopian tubes—and development continues there [1].

In this situation, the fertilized egg cannot survive outside the uterus, and the pregnancy cannot progress successfully. If the growing tissue is not treated, it can cause rupture of the fallopian tube and life-threatening internal bleeding [2].

What Causes an Ectopic Pregnancy?

Ectopic pregnancy is often caused by damaged, inflamed, or deformed fallopian tubes. A history of ectopic pregnancy or tubal disease is among the most important risk factors [2]. The main causes include:

• Sexually transmitted infections such as gonorrhea or chlamydia (pelvic inflammatory disease)
• Previous surgery involving the fallopian tubes
• A prior ectopic pregnancy
• Hormonal imbalances or abnormal development of the fertilized egg
• In vitro fertilization (IVF) or similar fertility treatments
• After tubal ligation procedures
• Smoking

Important note: In approximately half of women with ectopic pregnancy, no identifiable risk factor is found [1].

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What Are the Symptoms of an Ectopic Pregnancy?

In the early stages, ectopic pregnancy may not cause noticeable symptoms. Some women may experience early signs of pregnancy. A pregnancy test may be positive, but as the fertilized egg grows outside the uterus, the following symptoms may appear [1]:

• Breast tenderness
• Missed menstrual period
• Nausea and vomiting
• Pelvic pain (especially on one side)
• Vaginal bleeding
• Dizziness or fainting
• Increased abdominal pressure
• Digestive disturbances

Emergency symptoms: If the fallopian tube ruptures, sudden and severe abdominal pain, shoulder pain, heavy vaginal bleeding, and shock may occur. This is a medical emergency and requires immediate treatment [1].

How Is an Ectopic Pregnancy Treated?

Current treatment depends on beta-HCG levels, the patient’s overall condition, and the risk of tubal rupture [2]:

• Medical treatment (Methotrexate): Preferred in early-stage cases where the patient is stable and the tube has not ruptured. It stops cell growth and eliminates the pregnancy tissue.
• Laparoscopic surgery: If beta-HCG levels are high or medical treatment fails, the area is examined via laparoscopy. Depending on the damage, the fallopian tube may be repaired or removed.
• Open surgery (Laparotomy): If the tube has ruptured or internal bleeding is severe, emergency open surgery is required.