An ectopic pregnancy is a pregnancy that is located in the wrong place in a woman’s body.

Pregnancy begins when a woman’s egg joins together with a man’s sperm. These cells grow into a bigger group of cells, called an "embryo”. In a normal pregnancy, this embryo attaches inside the wall of the uterus (womb).

In an ectopic pregnancy, a woman’s egg joins with a man’s sperm and forms an embryo. But the embryo does not attach to the inside wall of the uterus. Instead, it attaches to a place in the body that it should not attach to and starts to grow. Even though the embryo gets bigger, it cannot grow into a baby. As the embryo gets bigger, it can cause pain and bleeding and other complications, some of which can be life-threatening.

In most ectopic pregnancies, the embryo attaches to the inside of one of the fallopian tubes (the tubes that connect the ovaries to the uterus). When this happens, it is also called a "tubal pregnancy”. In rare cases, the embryo can also attach to other places in the woman’s body such as the cervix, ovary, or the inside of the abdomen.

Embryos that do not implant in the uterine wall are generally unable to develop normally. In addition, an ectopic pregnancy can cause rupture of the organ on which they are implanted, typically the fallopian tube.

Rupture can result in severe internal bleeding, shock, and if there’s no early medical intervention, it can lead to death of the woman.

Fortunately, the ability to diagnose, monitor, and treat ectopic pregnancy reduces the risk of these life-threatening complications.

Some women have a higher chance than other women of having an ectopic pregnancy. A woman can have a higher chance of having an ectopic pregnancy if she; has abnormal or damaged fallopian tubes such as from past infections or surgeries, had an ectopic pregnancy before, is getting certain treatments to help her get pregnant or smokes cigarettes. 

Women who use a type of birth control called an "intrauterine device” or "IUD” have a very low chance of getting pregnant. But, if a woman using an IUD does get pregnant, she is at high risk of ectopic pregnancy and should have her doctor check her for ectopic pregnancy.

Women who have an ectopic pregnancy don’t always have symptoms early on. Some symptoms of early ectopic pregnancy might include lower belly pain and slight bleeding from the vagina (blood spots or brown staining).

Some women don’t have any symptoms until the ectopic pregnancy causes more serious problems. For example, an embryo growing in a fallopian tube can cause the fallopian tube to burst open. When this happens, the woman usually develops serious symptoms such as; severe lower belly pain, bleeding from the vagina, fainting or passing out, or feeling like you might faint or pass out and in extreme conditions, if no early intervention is done, can lead to loss of a woman’s life.

If one is pregnant and has any of these symptoms, it is highly advisable to go to the hospital and seek emergency care to avoid delayed complications.

To check if one has an ectopic pregnancy, the health care provider, usually a doctor or any skilled medical personnel, can do a blood test to measure a hormone called hCG and determine if one is pregnant and how much hCG the pregnancy is making, and perform an imaging test called an ultrasound to see where the embryo is located in the body.

The treatment for an ectopic pregnancy is done in two ways, depending on the size of the embryo, the woman’s symptoms, and other factors. Both treatments involve removing the embryo. A woman can be treated with; medicine that stops the embryo’s growth and causes it to dissolve, or surgery to remove the embryo which might or might not need removal of the affected fallopian tube.

Many women are able to have a normal pregnancy after having an ectopic pregnancy but need proper medical follow-up during the subsequent pregnancy to make sure everything is normal.

It is important to know that much as most ectopic pregnancies cannot be prevented, women have a higher chance of having an ectopic pregnancy if they get a lot of infections that are spread during sex. To reduce the chances of getting a disease from sex, one can use a condom. One can also quit smoking (if they smoke) to reduce the chance of having an ectopic pregnancy.                              

Dr. Ian Shyaka Resident in Surgery, Rwanda Military Hospital, iangashugi@gmail.com