The reversal of Roe v. Wade, the landmark legislation that guaranteed the federal right to safe abortion, has left people with plenty of questions about what will happen next with reproductive care in America. One question that keeps coming up is what this means for ectopic pregnancies.
Ectopic pregnancies are not considered typical pregnancies and are not viable, but they’re treated with medication that could be viewed as an abortion (using an “abortion pill”) under some definitions. Hence, all the questions.
But what is an ectopic pregnancy and how is it treated? Will there be any changes to this treatment in certain states going forward? Here’s what you need to know.
What is an ectopic pregnancy, exactly?
An ectopic pregnancy happens when a fertilized egg grows outside of the uterus, according to the American College of Obstetricians and Gynecologists (ACOG). More than 90% of ectopic pregnancies happen in a fallopian tube, which is one of a pair of tubes that eggs travel from the ovaries to the uterus.
As the pregnancy continues, the tube can burst and cause major internal bleeding, causing a life-threatening emergency that needs immediate surgery, ACOG says.
“Outside the uterus, it is not a sustainable pregnancy,” says women’s health expert Jennifer Wider, M.D.
What causes an ectopic pregnancy?
About half of all women who have an ectopic pregnancy don’t have known risk factors, ACOG says. However, the rest may have one or several of the following risk factors:
A previous ectopic pregnancy
Prior fallopian tube surgery
Previous pelvic or abdominal surgery
Certain sexually transmitted infections (STIs)
Pelvic inflammatory disease
A history of cigarette smoking
Being older than 35
A history of infertility
Having used assisted reproductive technology, like in vitro fertilization (IVF)
What are the symptoms of ectopic pregnancy?
Early on, an ectopic pregnancy will often cause the same symptoms as a typical pregnancy, including nausea, tender breasts, and a missed period, ACOG says. However, people who have an ectopic pregnancy may also experience the following:
Abnormal vaginal bleeding
Lower back pain
Mild pain in the abdomen or pelvis
Mild cramping on one side of the pelvis
As an ectopic pregnancy continues, a patient may have more severe symptoms, including:
Sudden, severe pain in the abdomen or pelvis
Weakness, dizziness, or fainting
How common are ectopic pregnancies?
About one in 50 pregnancies—or 2% of pregnancies—are ectopic, according to the March of Dimes.
How are ectopic pregnancies diagnosed and treated?
Ectopic pregnancies are typically diagnosed with an ultrasound, pelvic exam, and a blood test, ACOG says. “It really depends if someone has had a prior miscarriage or is going through fertility treatments,” says Lauren Streicher, M.D., a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. “Those women are closely monitored and will be detected early. Others will have an ectopic pregnancy detected during an ultrasound that does not find anything in the uterus.”
The fertilized egg can’t develop normally outside the uterus and it can’t be moved, ACOG says. So, in order to prevent life-threatening complications, the ectopic tissue needs to be removed.
Treatment depends on when the pregnancy was discovered and your symptoms, the Mayo Clinic says. In general, it may include medication or surgery. If the ectopic pregnancy is detected early and doesn’t have unstable bleeding, it’s usually treated with methotrexate, an injectable medication that stops cell growth and dissolves existing cells, the Mayo Clinic says.
If surgery is needed, the tissue will be removed laparoscopically or through an abdominal incision. The surgeon will also repair damage or remove the tube if the tube is ruptured.
Overall “recovery time can vary from a week to six weeks, on average,” Dr. Wider says. (If someone undergoes treatment with methotrexate, they will typically heal faster than those who need to have surgery, says Jessica Shepherd, M.D., an ob/gyn in Texas and founder of Sanctum Med Wellness.)
How does the Roe v. Wade reversal impact treatment for ectopic pregnancies?
It’s unclear. The reversal of Roe v. Wade has left decisions on abortion to states and treatment for an ectopic pregnancy could be considered an abortion by some definitions, Dr. Shepherd says.
“There are gray areas the law doesn’t address,” she says. “Some ectopic pregnancies still have fetuses with heartbeats and in states that have a ban on abortion and those who rely on heartbeat to determine if it is legal, it can cause some hesitation to treatment in this instance. Doctors may hesitate to perform procedures to treat these pregnancies for fear someone will accuse them of performing a covert abortion.”
This, Dr. Shepherd says, “impedes health care because physicians should not be fearful for being criminalized for taking care of patients.”
But Dr. Streicher says treatment for an ectopic pregnancy shouldn’t be considered an abortion. “An abortion is terminating a viable pregnancy—these are not viable pregnancies,” she says. “That’s why this is so mind-boggling that this could be an issue with Roe, but it is.” Dr. Streicher also notes that these pregnancies can be devastating for patients who “overwhelmingly” want to have a baby.
However, while a lot of the state legislature around abortion is still being decided, states typically have exemptions for when the life of the mother is in danger. Meaning, care for an ectopic pregnancy should still be considered legal.
If you’re experiencing symptoms of an ectopic pregnancy, contact your healthcare provider ASAP. It could turn into an emergency situation, so sooner is better when it comes to seeking care.
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