What to expect & how to cope with an ectopic pregnancy

Please note: This article has not yet been reviewed by a medical professional and is not intended to be taken as medical advice. Always refer to go to your medical provider for your medical care. This is intended to be peer-to-peer support only.

“Signing the papers was by far the most difficult thing I ever had to do. I felt extreme guilt because it was me who ended their life, had they had grown in the right spot they would have survived.”
Marie

 

“My babies would have lived if it had made it to my uterus .. It’s a whole different kind of grief.
And the fact that I only have one tube now instead of two was hard to process as well. I feel less than whole.”
Kristie

 

“I was not prepared for how long I would hurt after my tube ruptured. My tube had sharp pains for more than a year after my surgery, causing all kinds of anxiety as I thought I was having another ectopic. Afterward, my cycle was heavier than normal and wasn’t regulated at all. It truly took me about a year before I would say everything was ‘back to normal.’” Rachel

What to expect from your body in your ectopic pregnancy.

In less than one percent of pregnancies, a baby implants outside of the womb, or in a part of the uterus that is dangerous for implantation. Your baby may have implanted in any part of your fallopian tube, in your abdomen, in your cervix, in your ovary, in the opening of the tube to the uterus, or in a previous C-Section scar.

Here are some things you may experience physically as you go through an ectopic pregnancy:

Pain. Unlike regular uterine cramping, your pain may be debilitating. It may come and go suddenly, and it may progressively get worse as your pregnancy continues. Some women feel pain on one side of their abdomen, whereas others experience generalized pain radiating throughout the abdomen. Others feel pain in their rectum and feel excruciating pain when trying to use the bathroom. If you have experienced a rupture, you may feel pain in the tip of your shoulder. If your pain is so severe that it renders you incapable of standing or walking, or is sharp and sudden, please seek care in an emergency room.

Spotting. For some women, the first indication that the pregnancy is ectopic may be spotting, or light bleeding. While this is not always indicative of an ectopic pregnancy, this often is one of the first indications that the pregnancy may not be viable.

Bleeding. Your body may recognize that your baby is not growing in the right place and may try to miscarry. Just like a miscarriage, your body may undergo cramps and bleeding, with the passage of clots and your uterine lining. However, the majority of the time your body will not miscarry the baby, and medical management is necessary.

Continuing pregnancy symptoms. After my body “miscarried,” I was surprised that my pregnancy symptoms such as nausea and breast tenderness continued to increase in time. This is because hCG often continues to rise in spite of the bleeding and cramping in the case of ectopic pregnancy. If you believe you have lost a baby, but your symptoms increase, please check in with your medical provider.

Rupture. Ectopic pregnancies carry with them an inherent risk for rupture. Some women are aware when their tube or uterus has ruptured, and others only discover this in emergency care. My tubal rupture felt like a pop, then overwhelming, radiating pain that was so severe I could barely walk, and was instantly hit with nausea as my abdomen filled with blood. If you experience internal bleeding, it may cause pressure on your diaphragm, leading to deferred pain in your shoulder tip. Other symptoms of rupture include fainting or collapse, low blood pressure, nausea, and pale skin [source]. If your tube or uterus ruptures, you may go into shock. Please call 911 at any indication that you have experienced a rupture.

Treatment options for ectopic pregnancy:

Before we talk about the three ways to treat an ectopic pregnancy, I need you to know this: You did not choose this. Those who are unaware of the risks and realities of ectopic pregnancy may make you feel that you are choosing to end your baby’s life. Please know, nothing could be further from the truth. If you had your way, your baby would be healthy and whole, growing and developing in your womb. You are not choosing life or death for your baby — you are simply choosing to have the best chance at life yourself.

Ectopic pregnancies are not viable, as much as you and I wish they were. And as of yet, there is no procedure that can move your baby and re-implant your baby in a different location. As you decide with your doctor which of the three treatment options are for you, you may want to consider which treatment option makes you the most comfortable, which one you feel is the most compassionate for your baby, and which one respects the needs of your own body.

3 ways to treat your ectopic pregnancy:

Expectant management. If your pregnancy is suspected to be ectopic, but not confirmed, or if your hCG levels are dropping, you and your doctor may decide to proceed with expectant management. This is where you are carefully monitored through blood work and ultrasounds to monitor the progress of the pregnancy. According to The Ectopic Pregnancy Trust, you might be eligible for expectant management if:

• Your hCG is low.
• Your health is stable.
• You are not in severe pain.
• Your baby and the products of conception are small and you are not bleeding into your abdomen.

50% of ectopic pregnancies which meet these qualifications end in the body naturally miscarrying the baby [source].  However, because ectopics are notoriously unpredictable, expectant management means you must be carefully monitored, and should only pursue this treatment option if your doctor says you are a good candidate.

Medical management. If “watch and wait” is not the right course of action for your pregnancy, you may be given two other options — a drug called methotrexate or surgery. Methotrexate is a drug that prevents your baby from growing any further by inhibiting your baby’s use of folate, a necessary chemical for your baby to grow. It takes a few days for the drug to work, and your doctors will monitor your pregnancy levels closely over the course of a few weeks to make sure your levels are dropping appropriately. Your baby’s body and the placenta and sac will be reabsorbed into your body, but you can also expect to begin bleeding like a miscarriage.

After the injection, you may feel nauseous, exhausted, light-headed, sore, and crampy, and may begin to bleed vaginally [source]. Sometimes a second dose of methotrexate is necessary.

You may be a candidate for medical management if your hCG is less than 5,000, and everything appears stable. You will need to be very carefully monitored, and since rupture is still possible, even with low hCG numbers, you need to stay in close proximity to a hospital with an emergency department until the ectopic has been resolved.
The advantage of medical management is that it is non-invasive, and lessens the chance of permanent scarring on your tube — scarring which could increase your risk for ectopics in the future. The disadvantage is that it can take a heavy toll on your body, as it is the same drug they use in chemotherapy, and it may not work to prevent either rupture or the need for surgery.

Surgical management. Surgery is likely your best option if your hCG levels are higher than 5,000, if you have any signs that you are likely to rupture, if you have ruptured or have internal bleeding, or have any signs that your health is at risk. Most often, doctors create three small incisions in a laparoscopic surgery. Doctors will often save whatever they can of your reproductive system. Sometimes, they are able to repair the tube and sew it back together after taking the baby out. Sometimes they need to remove the entire tube or ovary, or both. In rare cases, a hysterectomy may need to be performed. Sometimes, doctors will not know what kind of treatment they will need to perform on you until they are in surgery and can fully assess the damage. If you lose too much blood, doctors may give you a blood transfusion.

After surgery, you will probably experience pain, discomfort, bloating, vaginal bleeding, and exhaustion.

“I went to the ER multiple times and was sent home each time with a threatened miscarriage. Even switched hospitals twice. I was told they could see the sac, cervix was closed, numbers were rising but slowly. I was dismissed as overly anxious about my first pregnancy. I finally drove two hours to my former OB/GYN who didn’t even need to perform an ultrasound or internal exam; she rushed me to a different hospital for emergency surgery to treat my first ectopic.”
Theresa

When to call your doctor:

Ectopic pregnancies are life-threatening and need prompt treatment. If you experience any of the symptoms listed above of an ectopic pregnancy, please call your on-call provider or head to the emergency room. If you have symptoms of a rupture, have someone else drive you immediately to the ER or call 911. If you have any symptoms of shock (clammy skin, rapid pulse, ashen face, nausea/vomiting, dizziness, fainting, rapid breathing, enlarged pupils, chest pain, confusion, or bluish lips or fingernails), call 911.

How long you may experience symptoms:

Ectopic pregnancies symptoms begin between 4-12 weeks and in some cases, extend into the second trimester. But most ectopic pregnancies resolve through treatment, or on their own, before the second trimester.

How long you feel the effects of your ectopic pregnancy will depend on how catastrophic the damage is, and what kind of treatment you received. If you pass the baby naturally with expectant management, your recovery will look much like that of an average first-trimester miscarriage. If you had medical management, you will likely feel the effects of methotrexate for several weeks. If you’ve had surgery or experienced a rupture prior to surgery, you can expect that you will not begin to physically feel like your normal self for several weeks, sometimes even months, especially if you suffered blood loss. The trauma of surgery plus the ectopic itself, blood loss, and plummeting hormones will all contribute to how you will feel.

Ask your doctor:

• If you would like to have your baby tested for gender or chromosomal abnormalities (some people find it helpful to grieve when they know the gender).
• If you would like to take the remains of your baby home with you to bury.
• What treatment options are best for your situation.
• What you need to look for as far as possible rupture, and when to seek emergency medical attention.
• For help with pain management, especially if you are recovering from rupture or surgery.
  If you have any physical constraints, like having sex, lifting heavy objects, exercising, going to work, etc.
  For a doctor’s note to excuse you from work or school.

Tips for preparation:

• If you are doing expectant management, follow all the preparation tips for first-trimester miscarriage.
• If you are having surgery or medical management, talk to your work to get adequate time off, and ask for help with childcare for your living children.
• If you had internal bleeding, talk to your doctor about if you are struggling with fatigue.
• Use heavy-duty pads, not tampons, for all vaginal bleeding.
• Have a support person come with you for your exams prior to surgery as you may end up in surgery immediately after your exam. If your surgery is scheduled, be sure to have someone stay with you and drive you to and from the hospital, and to stay with you during recovery.

Tips for postpartum care:

Treat your body with gentleness. No matter how your ectopic was treated, it is a trauma to the body. Be patient, kind, and gentle with your body.

Adjust your schedule as you can as you will likely experience a lot of fatigue from trauma and blood loss.

If you had surgery, follow all post-operative instructions. Care for your incisions as your doctor advises you, and be sure to call if you have any signs of infection. Ask your doctor if you have a weight limit on what you can carry.

Plan to wear loose-fitting clothes as you’ll likely have a lot of bloating from the gas they use in surgery, and you will be most comfortable if you’re not putting pressure on your incisions.

Give yourself some time to process. All loss is traumatic, but the added component of having your own life at risk can increase your feelings of trauma and fear. It may take time to fully understand what you have just gone through, and how much was at risk. Give your body and your mind time and space to process what just happened.

Surround yourself with support. Some do not understand the intense physical and emotional toll of ectopic pregnancies, and may not offer you the support you need. Do not be shy about asking for what you need, including help with meals, housekeeping, work, childcare, or even someone to go to appointments with you. (See Chapter 16 in Unexpecting for how to create a community of support following a loss).

Chapter 9 discusses how therapy with someone who is both trauma-informed and loss-informed can be a significant help as you work through any accompanying trauma.