Ep 206: What Does it Mean to Have an Ectopic Pregnancy?

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We’re doing a better job of talking about miscarriage but we don’t necessarily talk a lot about ectopic pregnancy loss. As I explain in the episode, an ectopic pregnancy happens when a fertilized egg implants outside of the uterus, usually in the fallopian tube. If that happens, it can be life-threatening and requires medical attention.

The emotional impact of an ectopic pregnancy can be the same as a miscarriage. Feelings of sadness, grief, and loss are common. Plus, it’s normal to experience anxiety and fear around your own health as well as what’s going to happen in future pregnancies.

The good news is that most often, an ectopic pregnancy will not affect your fertility. Listen to this episode to learn what warning signs to look out for and how to get the treatment you need. After you’ve received proper care, you should be able to go on to have a healthy baby.

In this Episode, You’ll Learn About:

  • What ectopic pregnancy is and what causes it
  • How common it is to experience
  • Whether you can do anything to prevent it
  • How doctors can tell the difference between an ectopic and normal pregnancy
  • Which treatment option is right for you

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Dr. Nicole (00:00): In this episode, you're going to learn all about ectopic pregnancy. Welcome to the All About Pregnancy and birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OBGYN, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy in birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/ disclaimer. Now, let's get to it.

(00:49): Hello there. Welcome to another episode of the podcast. This is episode number 206, and whether you are a new listener or a returning listener, I am so glad that you're spending some of your time with me today. Now, in this episode of the podcast, you're going to learn about atopic pregnancy. I actually got the idea for this podcast from someone who DMed me on Instagram asking for an episode about it. So here it is today. I'd definitely love to hear folks' suggestions about episode as a side note. So if you have anything that you want to hear on the podcast, then definitely shoot me a DM or an email. We're always interested in taking topics. All right. Now in this episode, you're going to learn what is a topic, pregnancy, what causes it, some of the statistics surrounding it, what are risk factors for ectopic pregnancy?

(01:38): You'll learn the signs and symptoms of ectopic pregnancy, how you can tell the difference between an ectopic pregnancy and a normal pregnancy will go through how ectopic pregnancies are diagnosed, and of course, treatment of ectopic pregnancy. There's medical treatment available. There's also surgical treatment available, the factors that determine the type of treatment risk and benefits of each. And then we will end with are there any ways that we can prevent ectopic pregnancy or you can prevent ectopic pregnancy. Now, before we get to the episode, I have a request. Can you share this podcast with three people? If you know someone else who's pregnant, if you know a childbirth educator, a doula, anyone who might be interested in this comment, go ahead and hit that. Share button and share this podcast. Sharing helps me to reach and serve more people. I am on a mission to reach as many folks as I can to help them have that beautiful pregnancy and birth experience that everyone so deserves, and I would just love your help in doing that.

(02:42): So share this podcast with three people right now. I would so appreciate it. All right, let's get into the episode on ectopic pregnancy. So first off, what is ectopic pregnancy? So ectopic pregnancy is quite simply when a fertilized egg and plants outside of the uterus so normal. Normally what happens in pregnancy is that the egg and sperm meet up in the fallopian tube, and then they travel back down the fallopian tube into the uterus where the embryo settles. Okay, and an ectopic pregnancy, something happens in that process, and most often the fertilized, the fertilized egg implants in the fallopian tube, about 95% of ectopic pregnancies are in the fallopian tube. Now, they can be in other places. They can also implant in the ovary, the abdomen, or the cervix, but most often ectopic pregnancies are in the fallopian tube. Now, I want to be very clear that unfortunately, this fertilized egg cannot develop properly.

(03:54): When is it? When it is outside of the uterus, and it can actually cause some severe complications. The biggest one is bleeding if it ruptures through that fallopian tube. As a matter of fact, ectopic pregnancy is a leading cause of maternal mortality in the first trimester. Bleeding from an ectopic pregnancy accounts for four to 10% of all pregnancy related deaths in the first trimester. So we have to be really, really careful about that. And you also can't move that ectopic pregnancy inside of the uterus. I know that conceptually that sounds like, oh, why can't we just move the pregnancy to the right spot? But unfortunately, that's not something that can be done. There is one study back in the 19 early 19 hundreds I want to say. It's a study that people often quote when they talk about that ectopic pregnancies can be moved. And in this study, it claims to have successfully moved an atopic pregnancy.

(04:54): But this study was done in the early 19 hundreds before there was ultrasound, before there was even HCG. So what most likely happened in that case is that the woman got pregnant again, not that it was a successful moving of an atopic pregnancy. So we have never successfully demonstrated, especially in modern times, that you can move an atopic pregnancy. Unfortunately, it is not viable if it's in the fallopian tube, and it cannot go to term and it can cause some severe problems, especially bleeding if it ruptures. Okay, so what causes an ectopic pregnancy? The most common cause we believe is some sort of blockage or damage in the fallopian tubes, and I'll talk about some of the things that can cause that damage in a minute. As I said earlier, the tubes are responsible for moving that fertilized egg from the ovary to the uterus. And if that tube is damaged or blocked, something's wrong with it, then the egg may just implant in the wrong place. Now, top pregnancy is also pretty common. ACOG estimates that it estimates that it happens in about one in 50 pregnancies. That's about 2% of all pregnancies. There are about 108,000 ectopic pregnancies every year. So very, very common. It's actually been increasing the incidence of ectopic pregnancy over the past few decades, mostly due to the rise in sexually transmitted infections in pelvic inflammatory disease, which is a severe consequence of sexually transmitted infections.

(06:28): So some of the risk factors for ectopic pregnancy are the biggest one is going to be a previous ectopic pregnancy. Like many things in medicine, if you have something before, then you are at our higher risk of it happening again. So if you had an ectopic pregnancy in the past, there is about a 10% recurrence risk to have another ectopic pregnancy. The next biggest thing is going to be a history of pelvic infections or sexually transmitted infections like gonorrhea or chlamydia. Those can cause inflammation in the tubes or inside of the pelvis that can make the fallopian tubes not work well. Endometriosis can also increase the risk of ectopic pregnancy. Endometriosis is a condition where what is normally shed during a menstrual period and comes out of the lining of the uterus into our vagina, tampon, whatever that normally goes out that way. In endometriosis, we believe that some of it goes backwards through the fallopian tubes and it can settle inside of the belly.

(07:38): That can cause scar tissue to form. That can cause the fallopian tubes to have damage. So that is how endometriosis can increase the risk of atopic pregnancy. Having had prior surgery like a pelvic surgery can increase the risk like removal of fibroids. A tubal lation, you're not likely to have an ectopic pregnancy if you had a tubal lation that's getting your tubes tied. But if you've done something to the tubes, removed a piece of the tubes, and somehow they scarred back together, you get pregnant and then a fertilized egg settles in that scar tissue area, it will increase the chances of ectopic pregnancy. In vitro fertilization can increase the risk of ectopic pregnancy. When an embryo is placed back into the uterus, they obviously place it as best they can inside of the uterus, but if it goes a little too far and settles into the fallopian tube, that can increase the risk as well.

(08:37): And then finally, maternal age over 35 and smoking also increased the risk of atopic pregnancy. Not very clear the mechanism of action of how those happen, but age over 35 and smoking also increased the risk. Now, I will say in about half of women have a diagnosis of ectopic pregnancy, there will be no known risk factors. So it's not that these risk factors are pretty common. About half of women won't have any of these risk factors, but those are some of the risk factors that we are most likely to see in folks who do have an ectopic pregnancy. So what are the signs and symptoms of atopic pregnancy? Well, some of the first signs and symptoms are going to be the same signs and symptoms of pregnancy because you're still pregnant. All right? So you may have nausea, you may have breast tenderness, your period will have missed.

(09:31): Okay? So you're probably or may have some of those same sorts of symptoms, but there's going to be some things that are distinguish it from distinguish a normal pregnancy from an ectopic pregnancy. The biggest one being abdominal pain. Abdominal pain is the most common symptom of ectopic pregnancy. And the difference is you can have cramping, kind of crampy sort of feeling when you have a normal pregnancy. But when you have an ectopic pregnancy, most often the pain is going to be on one side. Okay? You are going to be like, oh, I'm just having this pain on my right side, or I'm having this pain on my left side, and it's going to correlate with the side of the, that the ectopic pregnancy is on. All right? It can also be a sharp pain, also be a sudden kind of pain. Some of the pain can come from the ectopic pregnancy itself.

(10:30): Pain can also come from if the ectopic pregnancy ruptures. That's how the bleeding occurs. If the pregnancy gets so big that it burst out of the small space of the fallopian tube, the fallopian tube is pretty small. The length or the width of the fallopian tube is about the width of your finger if that and a pregnancy will outgrow that space fairly quickly. All right. So some of the pain may come from that rupture if that happens and bleeding in the belly. All right. You may also experience some light bleeding or spotting with an atopic pregnancy. Sometimes that can be mistaken for a period coming. You may also have in extreme cases, shoulder pain. If you have blood in your belly and it is so much blood in your belly that it's irritating your diaphragm, that pain will get referred to your shoulder. So your diaphragm is the big muscle underneath your lungs that moves up and down when you breathe. And if it gets irritated, it actually refers pain to your shoulder, and blood is a very strong irritant inside the belly. It's going to cause pain. You may also have, I said, nausea and vomiting earlier, but this can be pretty intense within atopic pregnancy. And then if you have internal bleeding, you can start to feel dizzy or faint because of an atopic pregnancy.

(11:53): Now, another way that we can distinguish an ectopic pregnancy from a normal pregnancy is following the pregnancy. H C G levels. H C G is human corona. That is the pregnancy hormone. And a normal pregnancy is going to double roughly every 48 hours. However, an ectopic pregnancy, that will not happen. It typically is going to rise more slowly or it may not rise at all. All right, so the big things again, just to go over that again, is that you're going to have a difference in the type of pain with an ectopic pregnancy. Abdominal pain is overwhelmingly the most common symptom, and it's going to be on one side or the other, wherever the ectopic pregnancy is. And then we can also tell the difference between a normal pregnancy and an ectopic pregnancy from that HCG level.

(12:46): And then of course, ultrasound can tell us the difference between an ectopic pregnancy and a normal pregnancy. And that is in fact, how we most often diagnose ectopic pregnancy. We do a transvaginal ultrasound to look and see where the pregnancy is. So the first thing we're looking for is just to see is the pregnancy inside the uterus or not? Okay? So that's the basic step. If it's inside the uterus, then it's not an atopic pregnancy. In rare circumstances, you can have something called a heterotopic pregnancy where you have a pregnancy inside the uterus, which is called an intrauterine pregnancy, and you have a pregnancy in the fallopian tube at the same time. That's a heterotopic pregnancy. That is very rare that that happens. It's most likely to happen in the setting of vitro fertilization, but it is a possibility that that can occur. So we diagnose ectopic pregnancy with an ultrasound, and there are some characteristic things that we can see on an ultrasound that are suspicious for atopic pregnancy.

(13:51): When you look at the area near the ovary of the fallopian tube, you can see what looks like a ring on the ultrasound that is in the area of the fallopian tube. You can also measure the blood flow around that ring. It's called a ring of fire. And if you see a lot of blood flow around that structure, that is very highly suggestive of an ectopic pregnancy. In rare instances, you may see an embryo with a heartbeat in the fallopian tube. That does not happen very common very commonly. Most often fallopian tube, most often atopic pregnancies do not get to that point where you can see an embryo in the fallopian tube. But occasionally, I would even say rarely that does happen. So you may see that on ultrasound. You also may see an ultrasound, a structure in the fallopian tube, and you can see blood in the belly or things on the ultrasound that are suggestive of blood inside of the belly.

(14:51): So ultrasound is really just black and white pictures. And we look at the differences and how gray, how white black they look in order to determine what the content is. And blood has a characteristic appearance on ultrasound. So there may be some things that are suggested of blood inside of the abdomen, which is suggestive of an ectopic pregnancy rupture. That's even if you don't see the ectopic pregnancy itself. Now, I want to be clear that ultrasound is not 100%, and ultrasound definitely does not catch all ectopic pregnancies. So we have to look at it in the context of not just a ultrasound. We have to look at the pregnancy hormone levels. We have to look at the medical history. When was the last period? How long should we expect that the pregnancy should be along? We have to base it on physical exam. Is someone having a lot of pain?

(15:45): Is someone having suggestions of internal bleeding? So ultrasound is great, but it is not the only thing or completely definitive in diagnosing ectopic pregnancy. Sometimes it takes a little bit to come to the diagnosis. All right. Okay, so how do we treat ectopic pregnancy? There are two big categories of treatment. One is medical treatment, one is surgical treatment, and then there's one other option that is not done as much, and I'll talk about that as well. So medical treatment is with a medication called methotrexate. Methotrexate is a medicine that interferes with rapidly dividing cells. Okay? I don't know why you will want to know this, but it's, it's a folate antagonist. And what that means is that it interferes with how folate is formed and it just will kill rapidly dividing cells. It also has some anti-inflammatory properties. So for that reason, methotrexate is actually a medicine that is used in the treatment of cancer because it kills rapidly dividing cells.

(16:56): Pregnancy is also a state of rapidly dividing rapidly growing cells, so it will also interrupt a pregnancy and stop the growth of pregnancy tissue. Your body will just absorb the pregnancy over time. And then as a side note, methotrexate is also used for because of the anti-inflammatory properties, psoriasis and rheumatoid arthritis. But again, in the context of pregnancy, it is stopping those rapidly dividing cells from developing. So methotrexate is a great option if you don't have signs of internal bleeding. You also have to have normal kidney function, normal liver function, you can't have any blood disorders if you have any problems with your kidneys or liver. Methotrexate can make that worse. So we can't give it in those circumstances. Something that's really important methotrexate is that you have to be able and willing to come to the appointments to have your blood H C G levels checked to make sure they are going down appropriately.

(18:05): Methotrexate can be given in one of two different ways. Sometimes it's a single dose protocol where you get a single dose of the methotrexate. Sometimes you get two doses. But either way, we really have to measure the pregnancy hormone levels four days afterwards, seven days afterwards. We don't always have to do day four, but we definitely have to do day seven to make sure that the pregnancy hormone levels are going down. So you have to be willing to come to those follow-up appointments, and you have to have access to medical care in order to come to those follow-up appointments to make sure we can track those HCG levels down to normal. Something that is also really important with methotrexate is that we have to be certain that the pregnancy is not in the uterus. All right? It's actually not as straightforward as you may think to diagnose where a pregnancy is, especially in the early stages.

(18:57): You cannot even see a pregnancy on ultrasound until the HCG level is over 1500. That's something called the discriminatory zone. And it doesn't get to be that high until about six weeks or so of pregnancy, five to six weeks of pregnancy. So if your HCG level is less than 1500, then we may not see a pregnancy on ultrasound in pregnancy, in the uterus, on ultrasound, you may see something in the fallopian tube that suggested topic pregnancy, but you may not see something in the uterus. And I say all that to say is that you have to be very certain that the pregnancy is not in the uterus with methotrexate, because as I mentioned, it's going to attack the pregnancy, or I shouldn't say attack. It's going to kill rapidly divided dividing cells wherever they are, even if it's a pregnancy inside of the uterus.

(19:48): So if you have a normal pregnancy inside of the uterus and you get methotrexate, it will cause significant damage to that embryo. Most likely it will result in miscarriage. If it does go on to be a pregnancy, the baby will have significant problems from being exposed to methotrexate. So we have to be certain that the pregnancy is not inside of the uterus before we give methotrexate some other sort of what are called relative contraindications or things where you have to be careful with methotrexate cause it may not work as well. If the HCG level is above 5,000, then it may not work as well. If it's a large ectopic pregnancy that's greater than three and a half centimeters, so that's a little over an inch. If it's a bigger atopic pregnancy, then methotrexate may not work as well, or you may need a second dose.

(20:42): If you can see cardiac activity on the ultrasound, then methotrexate may not work as well. So those are factors to consider as well. Also important with methotrexate is that you cannot get pregnant again until we know that the pregnancy hormone level has gone down to normal from the ectopic, and we know that that abnormal pregnancy has already been treated because if you get pregnant again then and it starts to rise, then we're struggling with knowing is this a normal pregnancy or is it just the ectopic wasn't appropriately treated, and that is not a good situation to be in. So until your pregnancy hormone level is back to normal, you also have to avoid getting pregnant when you get methotrexate. Okay, so the other option for treatment is surgery. That's typical. Typically laparoscopy. Laparoscopy is where we do tiny incisions and we put cameras and instruments into your belly through those tiny incisions.

(21:48): It's a much less involved procedure than what's called laparotomy or open surgery. So the recovery is pretty minimal and you go home the same day after laparoscopy. So really the standard of treatment for atopic pregnancy for a surgical approach is laparoscopy, unless there's some other reasons that you can't have laparoscopy. For example, if you've had a lot of surgery, a lot of scar tissue, then laparoscopy may be hard. But in general, laparoscopy is going to be the surgical approach if surgery is chosen. And if we do surgery, it's because of a few reasons. Typically it's because you are hemodynamically unstable. So what that means is you're showing signs of ongoing blood loss that is threatening your life. So your blood pressure is low, your heart rate is high, your hemoglobin is low, there are signs that you are having ongoing blood loss that is not safe.

(22:48): And in that case, then we need to do surgery right away in order to take care of the problem immediately and fix that atopic pregnancy. This I have seen in front of my eyes before where someone is literally hemorrhaging to death from an ectopic pregnancy. And in those instances, you really have to get going and get things going very fast because things can turn bad quickly. Okay? So surgery is the right option if there's some ongoing bleeding. Also, surgery is appropriate if you have that heterotopic pregnancy like I talked about with a coexisting normal pregnancy inside of the uterus. And in that case we can't do methotrexate, then you would have to have surgery. And most often surgery during pre pregnancy poses very little risk to an ongoing pregnancy. So that is the appropriate option. And then if you can't get methotrexate, methotrexate for some reason, if you have kidney problems or liver problems, then surgery is the right answer.

(23:47): Or if you got methotrexate and it didn't work, then surgery is the right option. All right. Now the third option, I'm going to briefly mention this. It is not done very frequently, but that is expected management. And what that is, is basically we just monitor your HCG levels and symptoms to see if the pregnancy resolves on its own. So if the ectopic pregnancy is really small and there are no signs of any complications, then we can do expected management. The times that I have seen this happen are the time or work well are the times when people are incidentally found to have an ectopic pregnancy. When they show up for their first prenatal visit, they weren't necessarily having pain or any symptoms or anything, and then you see the ectopic pregnancy, and then we just kind of follow up the hormone levels to make sure that it goes down.

(24:39): But this very, very rarely is chosen as an option expectant management for an ectopic pregnancy. So when choosing between the routes of treatment, methotrexate versus surgery, sometimes it's chosen for us. So if you are hemodynamically unstable, again, if you're having ongoing signs of bleeding, signs of bleeding, then surgery is the right option, 1000%. Okay, so that is very clear cut. Also, on the flip side, if you've had a lot of surgery, if operating on you for other reasons may be challenging, then in those instances, assuming you don't have any contra indications, then methotrexate will probably be the better option to avoid surgery. And I'm going to go through some of the benefits and risk of each approach in just a second. But I say all that to say is that sometimes it's not straightforward. Both options are perfectly reasonable methotrexate and surgery. So it really should be a discussion about your own unique circumstances and what you think may work best for you.

(25:47): All right? It's not always straightforward. That one has to be done over the other. It should be a discussion and presenting risk and benefits, and then thinking about it in the context of your own health. Now speaking, some of speaking about some of the risk and benefits for methotrexate, some of the benefits of methotrexate are that it will preserve your fallopian tube. It will preserve fertility. I didn't mention that laparoscopy most often involves removal of the fallopian tube. Very rarely are we able to preserve the fallopian tube. It can be done, but honestly, it's just not typically what's done. Often it's like we we're getting in, we're taking care of the problem and getting out, which involves just removing that fallopian tube. Okay? Now the good news is you have a fallopian tube on the other side. So people most often do not have any trouble getting pregnant in the future, but you will lose one of your fallopian tubes typically if you have laparoscopy.

(26:44): So whereas with methotrexate, the benefits are you can preserve that fallopian tube. Now, it may be a damaged fallopian tube, right? Because it had an ectopic pregnancy in it, so we had to take that into account, but you can preserve it. Methotrexate does not require surgery. It can be done on an outpatient, outpatient basis. And because there's no surgery, there's really no recovery from surgery. Now, some of the cons or risks are that it may not be as effective. It may not work. You do have to go in for that monitoring of the HCG levels. You may need to get treated again. So it does require frequent office visits afterwards in order to make sure. And by frequent, I mean once a week roughly. And if it doesn't work, then you're still going to have to have surgery anyway. Okay? Now, we're a surgical management.

(27:35): This takes care of the problem definitively. We're looking, we see it, we remove the pregnancy and it takes care of the issues. Now, I will say occasionally when we look inside for an ectopic pregnancy and we don't actually see the ectopic, we can see where it may have burst out of the tube. We can see that there's blood inside of the belly suggestive of an ectopic. Sometimes we don't see it. In those cases, it's suspected that it's in the blood, like it bursts out of the tube and the pregnancy is in the blood. So when we suck up all the blood and remove the blood in the abdomen, we are removing the pregnancy. But in general, surgery is going to be definitive treatment. It's done. We don't have to do a lot of follow up visits after that. Okay? Surgery is also going to be beneficial.

(28:21): Of course, if you have ongoing bleeding, that surgery is going to be lifesaving in that instance. All right? So that's the main benefits of surgery. It's quick. It gets the diagnosis definitively, and it can potentially be lifesaving. The risk are that most likely you are going to lose that fallopian tube, although with the other fallopian tube, most likely you're able to get pregnant. But it does reduce your risk of or reduce your chances of fertility by a little bit. There's also the associated risk of surgery and anesthesia. Surgery has risk like anything else. So you are doing that if you have surgery, and you're typically going to have a bit of a longer recovery time with surgery. Okay? Now, I can say that in my experience, people do fine with either option. So which either option you choose, people do well, all right? If you want to avoid surgery, then methotrexate is a great option. If you don't want to have to do follow-up visits and you want to have a definitive diagnosis, you want to see exactly what's going on, then surgery is a great option. So it's really dependent on your own unique circumstances.

(29:35): So what ways can ectopic pregnancy be prevented? Well, unfortunately, there is no guaranteed way to completely eliminate the risk of ectopic pregnancy unless you don't get pregnant or unless you don't have a uterus at all where you can get pregnant. However, effective contraception will prevent you from getting pregnant, which will subsequently reduce the risk of ectopic pregnancy. So using effective contraception is going to be the best way to reduce your risk of ectopic pregnancy. Also, avoiding smoking will help reduce your risk of ectopic pregnancy. We know that smoking increases the risk of atopic pregnancy. You definitely want to seek treatment for sexually transmitted infections. It's actually recommended by the C D C, everyone 25 and under gets routinely screened for sexually transmitted infections. This is not something that I think we always do a great job of. And these infections can be completely asymptomatic at the time, meaning you have zero symptoms of anything going on, but you can be carrying around chlamydia or gonorrhea, and that can be causing damage to your tubes.

(30:50): So if you're sexually active, you're concerned about a non-monogamous relationship, or you just want to know, then get tested for chlamydia and gonorrhea and get those treated. They're easy peasy to treat in the office. Definitely if you had a prior ectopic pregnancy, when you get pregnant the next time around, you absolutely want to present to prenatal care early. You want to be clear that you had an ectopic pregnancy before because you're going to be at an increased risk. So it's like, Hey, I'm pregnant again. I had an ectopic pregnancy because we're going to want to get you in earlier for prenatal care to make sure that we can identify exactly where that pregnancy is and that it is in the right place. And then I do want to say one final thing about contraception and birth. In atopic pregnancy, IUDs have been shown to significantly reduce the risk of atopic pregnancy compared to other hormonal contras or non-hormonal contraceptive methods.

(31:54): Hormonal IUDs may also lower the risk, but there's not as much research showing that. Now, the thing about contraception or IUDs in particular is if you do get pregnant with an IUD, then the pregnancy is more likely to be an ectopic because you have that i u d inside of your uterus, the embryo can't implant inside your uterus, so it's more likely to implant outside of your uterus. So when you see things discussing ectopic pregnancy and IUDs, it overall, the risk of ectopic pregnancy with an IUD is low, okay? But if you do get pregnant with an IUD, it's more likely to be an ectopic pregnancy. All right? So there's a difference there.

(32:39): Okay, and the final thing I want to talk about is some of the emotional reactions and things that may happen surrounding atopic pregnancy. This is something that's similar to miscarriage. We don't appreciate enough in OBGYN, some of the emotional impact of having atopic pregnancy. If this was a planned pregnancy, if you were experiencing fertility struggles, there can be an intense feeling of sadness. There can be grief, there can be loss after an ectopic pregnancy, that's that's very, very normal. There can also be some anxiety and fear. As I said, ectopic pregnancy can be a life-threatening condition, and so you can definitely have some anxiety and fear about your own health as well as what's going to happen in future pregnancies. There may be some guilt and self blame, like, if I didn't sleep with that a-hole in college who gave me gonorrhea, then I wouldn't be in this situation where I now have an ectopic pregnancy.

(33:44): Okay? Do not blame yourself or anything like that. Most ectopic pregnancies are caused by factors that are outside of your control. And then it can also be a sense similar to miscarriage of isolation and loneliness. I think we're doing a better job of talking about miscarriage and pregnancy loss, but we don't necessarily talk a lot about ectopic and the loss of pregnancy in that regard. You may not feel like you have support from family and friends, especially since some of the language around ectopic is you're at an increased risk if you've had a pelvic infection, infection or sexually transmitted infection or that kind of nonsense where there's a negative connotation in that regard. So it can feel lonely, it can feel isolating. It can feel like something that is difficult to talk about. So I say all that to say is do take care of yourself in the context of having any sort of pregnancy loss, including in atopic pregnancy.

(34:46): It may mean that you join a support group. There are support groups online. It may mean that you connect with other people who've had similar experiences. Maybe you journal about it. Maybe you see a counselor or a therapist who was adept at helping people process reproductive related trauma and helping you process those emotions. So know that it is perfectly normal to fear all, to feel all of those things, sadness, fear, maybe even anger, grief, all of those things. But do take care of your emotional and mental health in the process as well. Also know that I'm, again, I've said it repeatedly throughout the episode, but I'm going to say it again. Most often if you have an ectopic pregnancy or you are able to go on and have children in the future, and your fertility is not adversely affected, all right? It is very rare that you have an ectopic pregnancy and you cannot have children in the future.

(35:41): Okay? All right. So just to recap, ectopic pregnancy is a pregnancy outside of the uterus. About 95% of the time it's going to be in the fallopian tube. Ectopic pregnancy can be dangerous if it ruptures out of that fallopian tube, it can cause life-threatening hemorrhage. In fact, atopic pregnancy is a leading cause of death in the first trimester. That is why it's just so important to seek care. When you have any concerning signs or symptoms, the most common sign is going to be one sided abdominal pain on the right side, the left side, one side, one sided abdominal pain, as well as signs and symptoms of pregnancy like nausea, breast tenderness, you have missed your period. Ectopic pregnancy can be treated with methotrexate, which is a medication or surgery. Each of those has pros and cons. Methotrexate is great for if you want to avoid surgery, but you do need to be able to attend follow-up visits.

(36:41): Surgery is great for getting the procedure done and getting definitive treatment, but you're most likely going to lose your tube in that instance. Surgery is the appropriate treatment if you have any life-threatening, bleeding or hemorrhage going on inside of your belly. And then the final thing, again, most often after atopic pregnancy, you will be able to go on and get pregnant and have healthy, normal pregnancies and babies. Okay, so there you have it. Do me a solid, again, share this podcast with three people. I am on a mission to reach and serve as many folks related to pregnancy and birth as I can, and I would so appreciate your help in doing so. So share this podcast with three friends. Also subscribe to the podcast wherever you're listening to me right now, that will help you not miss any episodes, and it helps other folks find my show.

(37:38): I'd love to hear what you think about the show. So reach out to me on Instagram, shoot me a dm. Let me know what you think about any of the episodes. Let me know if you have any suggested topics. As I mentioned at the top of the episode, I did this episode at the suggestion of someone who DMed me on Instagram. So shoot me on a DM on Instagram at Dr. Nicole Rankins and follow me there too. I do lots of fun, pregnancy and birth information there on the gram as well. So that is it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.