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In an ectopic pregnancy, the fertilized egg implants somewhere other than in the cavity of the womb, usually in a fallopian tube. The rapidly growing embryo causes the tube to distend, and the invading placenta weakens its walls, causing bleeding. Eventually the tube bursts under the strain.

Before a fallopian tube bursts, there are usually certain symptoms around the sixth week of pregnancy that signal all is not well. If you should notice any of these, it’s important to report them to your doctor immediately. Doctors define two forms of ectopic pregnancy:

Unruptured After a positive pregnancy test, warning signs of an ectopic pregnancy may be pain in the abdomen, usually only on one side, sometimes accompanied by vaginal bleeding, fainting, and pain in the shoulder (on the same side as any pain in the abdomen). Sometimes an ectopic pregnancy is detected by an ultrasound scan after a small amount of bleeding from the vagina early in the pregnancy. Although there’s some leakage, there is no rupture as yet, and it may not be detected until eight to 10 weeks’ gestation. This kind of ectopic pregnancy can sometimes be treated by injecting a drug into the embryo, causing it to die and then be reabsorbed, which can save the fallopian tube. Otherwise the pregnancy can be removed by laparoscopy.

Ruptured This happens when the tube bursts, leading to severe pain and shock, with extreme paleness, weak but rapid pulse, and failing blood pressure. A woman suffering this acute form of ectopic pregnancy will be admitted to the hospital immediately for emergency surgery. The pregnancy will be removed from the fallopian tube and the tube itself may also have to be removed.

Ectopic pregnancy is becoming more common in developed countries. We don’t know why, although some doctors think there could be a link with increases in pelvic inflammatory disease, which causes scarring and blockage of the fallopian tubes. On the other hand, there may just appear to be more ectopic pregnancies because doctors are better able to diagnose them, thanks to ultrasound.

Outlook Almost 60 percent of women who’ve had an ectopic pregnancy become pregnant again, 30 percent avoid further pregnancy voluntarily; the rest are infertile. If you have had a previous ectopic pregnancy, tell your doctor because you will need special care during your current pregnancy.

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