“Ectopic Pregnancy: Right Time, Wrong place!” – with Dr. Lis Shlansky
Share this post:
In this episode, Drs. Fox and Shlansky discuss ectopic pregnancy. Dr. Fox describes ectopic pregnancy as an overlap between gynecology and obstetrics, and explains that it is one of the earliest problems that can occur with a pregnancy and that it can be very dangerous.
Dr. Shlansky explains that “in it’s simplest terms, it’s a pregnancy that happens outside the uterus,” meaning that an ectopic pregnancy can be in the abdomen, ovary, cervix, or tube. Because the uterus is, Dr. Fox explains, “the only place that a pregnancy can grow and thrive,” an ectopic pregnancy is not considered viable and can cause excessive bleeding and potentially death for the mother. Dr. Fox says that “these pregnancies will not grow into babies who will be born and survive,” and that treating them is “not the same as an abortion.” Further, he explains that an ectopic pregnancy “can’t be removed and placed in the uterus.”
Ectopic Pregnancy Risk Factors
There are several reasons why a patient may be at an increased risk for an ectopic pregnancy. Those who have had a previous injury to their tubes, due to a surgery or STD, may have increased risk. Dr. Fox explains that fertilization happens within the tube, and that normally the tube then “gently massages” the embryo towards the uterus. Damage can disrupt this from happening.
IVF transfer patients can also be at higher risk. In addition, those with IUDs in place can be at higher risk if they become pregnant. However, this is exceedingly rare, as the IUD should prevent them from becoming pregnant in the first place.
Diagnosing and Treating Ectopic Pregnancy
Dr. Shlansky explains that she would be suspicious of an ectopic pregnancy based on the patient’s symptoms such as missing a period and having pain in the pelvic area. Definitive diagnosis is completed by surgery, but she says “ultrasound is also so well-developed at this point that most ectopics can be diagnosed by ultrasound.” Most ectopic pregnancies are diagnosed very early, as past 6 weeks or so, the patient is likely to have bleeding and more intense pain.
Dr. Fox says that while patients are not always aware, “when someone comes in with an early pregnancy…the first thing we want to make sure is whether it’s in the uterus.” Dr. Shlansky says that ectopic pregnancies “tend not to follow the mold or the pattern for a normal pregnancy,” and that monitoring hormones can indicate an ectopic pregnancy.
Treating ectopic pregnancy is often done through surgery. This is generally done through a small incision in the abdomen. Dr. Shlansky explains that the physician may then either “milk” the ectopic pregnancy out or simply remove the tube if it is too damaged. She explains that “if the tube is damaged, the likelihood of another ectopic is about 50%,” so the choice is made to remove the tube to prevent future ectopic pregnancies.
Another option is to treat the ectopic pregnancy with Methotrexate, which is a drug that blocks cell division. This stops the pregnancy from growing, and it will then regress, shrink, and dissolve. Dr. Fox says he explains to patients that Methotrexate is similar to cancer treatments, though it doesn’t have the same side effects as chemotherapy, and that it is administered by an injection.
Dr. Shlansky explains that a patient can try to get pregnant again once her hormones have returned to normal and she’d had a period again. The likelihood of another ectopic pregnancy at this point is usually around 2-3%, and generally no higher than 10%.