4 days ago
All you need to know about: ectopic pregnancies
A recent case of pregnancy stunned doctors in Bulandhshahr, Uttar Pradesh: an MRI scan, conducted after the pregnant woman complained of vomiting and stomach pain, revealed a foetus growing in the liver, as per media reports. This extremely rare condition is known as an intrahepatic ectopic pregnancy.
Additionally, as Ectopic Pregnancy Awareness Day went by last week, on August 1, a day dedicated to highlighting this condition and the experiences of those who have been affected, here is all you need to know about it.
What is an ectopic pregnancy?
An ectopic pregnancy occurs when the fertilised egg, instead of implanting itself in the uterus, implants outside of it, commonly in the fallopian tube. This sort of pregnancy cannot proceed normally. It could cause bleeding, and may even be life-threatening in some cases.
Pregnancy begins with fertilisation of a sperm cell and and egg cell. The fertilised egg is then meant to travel down the fallopian tubes, which are tubes that connect the ovaries to the uterus, and attach itself to the lining of the uterus (womb). In an ectopic pregnancy, the fertilised egg attaches itself to a structure other than the uterus. When it attaches to the fallopian tubes, it is called a tubal pregnancy. Rarely, the fertilised egg may attach to the ovary, abdominal cavity or cervix. Since only the uterus is meant to carry a growing embryo, these pregnancies cannot continue.
Why do ectopic pregnancies occur?
Ectopic pregnancies occur when the movement of the fertilised egg is blocked. This could occur due to inflammation or scarring of the fallopian tubes, damage to the fallopian tubes (due to prior surgeries or infections), or an irregularly-shaped fallopian tube.
Risk factors for ectopic pregnancy include: a prior ectopic pregnancy, having had certain sexually transmitted infections, surgery of fallopian tubes, a history of smoking, infertility and fertility treatments, endometriosis, and having an intrauterine device in place at the time of conception. Advanced age (over 35) is also a risk factor.
However not all women will have any or all of the risk factors.
How common are ectopic pregnancies?
A 2023 research paper, Clinical Profile, Risk Factors and Outcomes of Ectopic Pregnancy in a Tertiary Care Hospital: A Prospective Indian Study published in Cureus, noted that the incidence of ectopic pregnancies in India has been reported in the range of 0.91-2.3%. The study found that amenorrhea (absence of menstruation) was the most common symptom seen in the cases it analysed. On ultrasound, the most common finding was tubo-ovarian mass. In the majority of patients studied, the ampullary region in the fallopian tube was the site of the ectopic pregnancy.
According to the 'Global burden of ectopic pregnancy from 1990 to 2019: A tendency, forecasted trend and inequality analyses based on the Global Burden of Disease Study 2019', in the European Journal of Obstetrics and Gynaecology and Reproductive Biology, in June 2025, the number of ectopic pregnancies has fallen from 1990 to 2019. The study however highlights the significant burden of ectopic pregnancies, especially for low socio-demographic index countries. Addressing health inequality is crucial for developing effective intervention policies to improve global maternal health outcomes, it notes.
What are the signs and symptoms of an ectopic pregnancy?
Ectopic pregnancies don't always cause symptoms. Some symptoms may also be similar to those in early pregnancy such as a missed period, nausea and tenderness of breasts. Other symptoms may become noticeable later and may include: vaginal bleeding, pain in the lower abdomen, as well as pelvic and back pain, dizziness, pain in the shoulder, discomfort during bowel movements, and low blood pressure.
The rupture of the fallopian tube, with sudden, sharp, abdominal pain and extreme light-headedness is a medical emergency as it can cause severe, internal bleeding. Immediate medical attention is required as it can be life-threatening.
How is an ectopic pregnancy managed and treated?
Many women may not know that their pregnancy is ectopic until they see a healthcare provider. Urine, blood tests and ultrasounds may be required for the doctor to arrive at a diagnosis. They are generally diagnosed early in the pregnancy.
Since a pregnancy cannot proceed outside the uterus, an ectopic pregnancy is usually treated with medication or surgery. A common medication used is methotrexate: this stops the cells of the fertilised egg from growing and helps dissolve existing cells. This medication cannot be taken if the fallopian tubes are ruptured. It is important to have a confirmed diagnoses prior to taking the medication. After the medication is taken, follow-ups are required to monitor blood hCG levels (detection of pregnancy) and to determine if more medication is needed.
In some cases, surgery may be required. Laparoscopic (keyhole) surgery is generally performed. The surgery may involve removing the egg from the fallopian, or removing both the egg and the tube. This depends on the amount of bleeding incurred, damage to the tube and other factors. In case of a ruptured tube, emergency surgery may be required.
What happens after an ectopic pregnancy?
Losing a pregnancy can be very difficult, and feelings of loss can last for a long time. It is important to seek help if required. Consulting a healthcare provider about future pregnancies is recommended. There is a higher risk for another ectopic pregnancy after having had one; however most women can go on to have successful pregnancies.
