Ectopic and Molar Pregnancies
Ectopic pregnancy is a form of pregnancy loss in which the fertilized egg starts developing outside the uterus, usually in the fallopian tube. Ectopic pregnancies have become much more common in recent years. They can happen to anyone, but the risk is higher for women who have had previous tubal surgery, including for a previous ectopic pregnancy, and tubal reversal surgery, and for women whose mother’s were given DES. They are also more common in women who have pelvic inflammatory disease (PID) or who used IUDs.
Ectopic pregnancy can be a life-threatening condition that requires immediate treatment. If the tube ruptures, you may experience severe blood loss and go into shock. Because the hormonal changes are similar to those of a normal early pregnancy, you can have all the early signs of pregnancy, such as fatigue, nausea, missed period, and breast tenderness and a positive pregnancy test. Vaginal bleeding is a common symptom. As the pregnancy progresses, causing pressure in the tube, symptoms such as stabbing pain, cramps, or a dull ache may become severe. Neck and/or shoulder pain mean that an ectopic pregnancy has ruptured and there is blood in the abdominal cavity.
Diagnosing an ectopic pregnancy can be tricky. If you suspect something is wrong, ask your practitioner to check your hormonal levels every other day and do a vaginal ultrasound as early as possible. Ectopic pregnancy is sometimes misdiagnosed as an early miscarriage. Thus, a blood pregnancy test should always be done after a suspected miscarriage to make sure no fetal tissue is present in the tube. It is essential to check any tissue passed from the uterus and to make sure that your hormone levels have returned to zero, to confirm or to rule out ectopic pregnancy.
|I had my second ectopic pregnancy in January in 1993. I was undergoing fertility treatment, using Clomid to stimulate ovulation and when the home pregnancy test was positive we were thrilled. We called my parents; they were thrilled. We told everybody. I lost the pregnancy at about 7 weeks. I’d been spotting and an ultrasound showed no heartbeat. A few days later I came back and had the D&C and walked out of there drained, miserable, exhausted. About a week after the D&C I was teaching my graduate seminar and suddenly I just fell over. I was having exceedingly severe pain. I didn’t know what the hell was going on. My stomach swelled because blood was pooling there and a student helped me unbutton my pants. Then I passed out. The EMTs came and were shouting at me because I was in shock, asking me if I was pregnant and I explained I wasn’t, that I had just had a D&C. “Are you sure you aren’t pregnant?” and I said “I can’t be.” My blood pressure was so low that they put me in a special suit. In the ER I was rushed into an operating room and a doctor told me that they were going to have to cut me open to find out what was wrong. I have a rare blood type and while they were waiting to get the blood ready my fertility specialist arrived. He figured out that two embryos must have implanted—one in my uterus which I had miscarried, and a second one in a tube which hadn’t shown up on the ultrasound. My tube had ruptured and he was able to remove it using laparoscopy. If he hadn’t arrived when he did, I would have had to have abdominal surgery. I remember telling him that I want to donate the embryo to research and “Oh no, oh no. We would never do that.|
I had my ectopic when I was 26 yrs old. I was working for an architectural firm and my boyfriend had just left me. One day I started spotting and went in to see my gynecologist. She said it’s either an cyst or an ectopic pregnancy. That was back when it took 3 days to get the results of a pregnancy test. She called me on Friday afternoon and told me it was an ectopic and that I needed to go immediately to the hospital. I was examined and the doctor who did the examination told the internist to be careful when examining me because it was about to burst. He said it felt like a hard-boiled egg. They had to remove my tube and I worried until I became pregnant with my first born whether I’d be able to have a child after that.
When doctors detect an ectopic pregnancy early enough, they make every effort to remove the pregnancy and save the tube. Increasingly, physicians are using the drug methotrexate to dissolve the embryonic tissue, administering it intravenously or intramuscularly, or injecting it into the tube. Another alternative is a laparoscopy, which is generally preferable to abdominal surgery. Sometimes it becomes necessary to remove the whole tube (in the past, the ovary used to be removed also). Careful surgical technique is important; the less bleeding and consequent adhesions and scar tissue, the better the chance for a normal pregnancy later.
It is natural for women who have had an ectopic pregnancy to experience all the feelings of a miscarriage, including depression and fear that it could happen again. In addition, you may have had internal bleeding, undergone the trauma of an emergency surgical operation, and you may have concerns about being able to get pregnant again. Supportive friends and/or a women's support or pregnancy loss group can help you air and ease your feelings. There are also “subsequent pregnancy groups” that can help.
In some pregnancies there is a major error in the initial cell division and an embryo does not begin to grow but instead the cells that are supposed to develop into the placenta develop into a tumor. This condition has several names and varieties—gestational trophoblastic disease, hydatidiform mole (which may be “complete,” “partial” ). Not only is the pregnancy lost, grief is complicated by the fact that there was no baby.
|I was sixteen weeks pregnant with my second when I started to bleed. I remember sleeping with my legs tightly together hoping nothing more would happen but I continued to bleed. My husband and I went in for an ultrasound and they said that there was no heart beat there. It was five days after the D&C that they called and said I had had a molar pregnancy. It made me very confused because I didn’t know if there had been a baby in there and it was very important to me to visualize the baby so I remember being very confused about that.”
The news of the trophoblatic tissue put me into high gear. Keep busy. Or sleep. Can’t stop to think, can’t stop to cry. I feel driven. I need to stop and mourn, but how can I feel it necessary to mourn when there wasn’t even anybody in there!?”
Molar pregnancies are rare in the US (1 in 1,500 live births) but rates go up with age and are much more common among Asian women. They usually don’t affect your chances of having a normal pregnancy the next time. Because the abnormal growth may spread, it is important to have a D & C and to have hormone levels checked for a period of time afterwards.
|I told Mom about the trophobalstic disease in such reassuring terms that I felt ripped off when she wasn’t worried. Mixed messages I give—please everyone, pay this no mind, not to worry and then—WORRY ABOUT ME! Be concerned! Relieve me of this fear and worry.|
Written by: by Linda Layne
Last revised: March 2005
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