Are ectopic pregnancies increasing?
A notable increase in the number of women seeking emergency care for ectopic pregnancies is causing obstetricians and emergency room physicians to take notice.
A recent large-scale study of nearly one million pregnancies over a decade found “significant increase” in ectopic pregnancies.
The study confirmed ectopic pregnancy remains one of the leading causes of maternal mortality in the United States. In addition to highest trends for younger women, the incidence was particularly higher for mothers over 40 years in age and non-Hispanic Black women.
- 2006–2010: The rate of ectopic pregnancy diagnoses per 1,000 pregnancies increased from 7.0 to 8.3.
- 2010–2019: The annual incidence increased from 15.2 to 16.4 per 1,000 pregnancies
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Why is this so concerning?
The American College of Obstetricians and Gynecologists (ACOG) reports that more than 90% of all ectopic pregnancies occur in a fallopian tube, but some pregnancies actually implant in the abdomen, cervix, ovary, or a cesarean scar.
The uterus is the only organ that can hold a growing baby. When a baby implants in the fallopian tubes, they do not stretch and can rupture when forced to expand. An ectopic pregnancy poses imminent harm or death for pregnant women if not diagnosed and treated promptly.
Because there are two patients to be considered in any pregnancy, the American Association of Prolife Obstetricians and Gynecologists (AAPLOG) gives insight that this type of pregnancy represents a life-threatening condition to the maternal patient, whose life is equally to be defended when management options are reviewed with patients.
How does this increase threat to women relate to chemical abortion?
Healthcare professionals treating patients in emergency departments following the start of a chemical abortion are sounding the alarm regarding a new hidden danger– chemical abortion and undiagnosed ectopic pregnancy. For those skipping over any assessment or ultrasound prior to beginning an abortion, ectopic pregnancy is always a possibility.
The abortion pill and ectopic pregnancy actually exhibit similar symptoms and the drugs can mask the presence of an ectopic pregnancy.
AAPLOG is calling it a “deadly convergence that cannot be ignored.”
The significant increase use of chemical abortion has created even more dangers for women who are self-managing their abortions and symptoms. Based on the FDA’s and abortion industry’s data, over 25,000 women and girls were forced to obtain emergency care after taking abortion drugs.
Many women are now obtaining abortion pills through individual telehealth providers, organizations such as Hey Jane, Carafem, and AidAccess, as well as a variety of abortion websites without preassessment. This access is a result of the removal of abortion drug safety protocols by the FDA.
Tweet This: The significant increase use of chemical abortion has created even more dangers for women who are self-managing their abortions and symptoms
A recent study highlighted the increase and the critical need for clinicians to be prepared “to meet the needs of patients who may be considering self-managed medication abortion or who need or want to connect with the formal health care setting for postabortion care.”
What is causing the increased numbers of ectopic pregnancies?
Certain birth control and emergency contraception
The increased use of IUDs is causing ectopic pregnancies to soar. Ectopic pregnancy is 600% more likely to occur if conception takes place while an intrauterine device is in place. Pregnancies diagnosed during the use of the IUD are usually in the fallopian tubes, giving evidence that the embryos which survive to enter the uterus are selectively “lost”.
IUDs are increasingly becoming the birth control method of choice with the Center for Disease Control reporting use of intrauterine devices has tripling since 2006: from 7.7% to more than 21% in the period 2015- 2019.
Another type of birth control also presents increased danger.
Women on continuous “progestin-only contraceptives,” with the exception of Depo-Provera users, are at increased risk of ectopic pregnancy. With the levonorgestrel implants (such as Norplant), the risk is a staggering five times as high for ectopic pregnancy.
Since fertilization happens in the fallopian tubes and the baby has need to move to the uterus for implantation, any changes to the mobility and tubal transport can cause an ectopic pregnancy. The effect of progestins on the tubal environment is potentially significant, creating challenges for the baby to move to the uterus.
Emergency contraception can also a role in affecting a baby’s ability to implant in the uterus.
Planned Parenthood admits that most women do not know their exact time of ovulation and EC is completely ineffective during ovulation. If EC fails to prevent ovulation, there may be an increased risk of ectopic pregnancy. Levonorgestrel, mentioned previously as proven to increase risk, is often used as an EC.
STDs, STIs and PID
Those with sexually transmitted diseases and infections are at greater risk. Women having a history of pelvic inflammatory disease (PID) have a threefold increase in ectopic pregnancy risk. Gonorrhea and chlamydia infections, the primary causes of PID, have been drastically increasing in the U.S.
A history of pelvic inflammatory disease is also strongly associated with ectopic pregnancy. Women having a history of pelvic inflammatory disease (PID) have a threefold increase in ectopic pregnancy risk. This is directly connected to the increase in gonorrhea and chlamydia infections, the primary causes of PID, have been increasing.
Often it is unknown what is the exact cause of an ectopic pregnancy. However, it is well known that there are a number of risk factors for an ectopic pregnancy diagnosis. These include any damage to the fallopian tube (often from an STI or PID), diagnosis (scar tissue, adhesions or inflammation), device or drug (IUD, progestin-only birth controls, EC.) Essentially anything that hinders the progress of an embryo within the fallopian tubes can increase the chances of an ectopic, such as:
- Previous ectopic pregnancy
- Fertility treatment
- Older age
- Pelvic Inflammatory Disease
- Tubal surgery
- Endometriosis
- Abdominal surgery
- Intrauterine Device (IUD)
- Emergency Contraception
- Cigarette smoking
What are the signs and symptoms of an ectopic pregnancy?
- Vaginal bleeding
- Pain in lower abdomen, pelvis and lower back
- Dizziness or weakness
If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause additional symptoms. These can include:
- Fainting
- Low blood pressure (hypotension)
- Shoulder pain
- Rectal pressure or bowel problems
How is an ectopic pregnancy treated?
Treatment of ectopic pregnancy depends on the gestational age, symptoms, and location of the gestational sac.
AAPLOG explains that in treatment of the ectopic pregnancy, the baby has typically died by the time of discovery. However, the supporting tissue often continues to grow which puts the mother’s life in imminent danger from a hemorrhage. Continuation of such a pregnancy is not possible. Early treatment gives hope for future fertility.
Treatments can include:
- Letting the ectopic pregnancy heal and the body absorb it on its own
- Using the medicine methotrexate to stop the pregnancy from growing further
- Using surgery (usually laparoscopy) to make a small opening in the fallopian tube. The surgeon removes the pregnancy and sometimes the tube
Tweet This: A recent large-scale study found significant increase in ectopic pregnancies; but healthcare systems can work to protect women.
How can our healthcare systems protect women from this significant cause of maternal mortality in the United States?
- Pregnancy testing and assessment to identify early pregnancy
- Bloodwork to confirm hcg levels if no confirmation of IUP
(The rate of rise of pregnancy hormones tends to be abnormal in cases of pregnancy in ectopic implantations.) - Early ultrasound to confirm intrauterine pregnancy
(A retrospective study of 585 women over a 2.5-year period concluded that the sensitivity and specificity of ultrasound for the detection of ectopic pregnancy was 88.5% and 96.5% on the first ultrasound and 93.1% and 95.7% after an additional scan.) - Frequent STD/STI testing and treatment
- Provide patient education and warnings for devices and drugs that increase risk along with non-damaging alternatives
- Require the exclusion of an ectopic pregnancy prior to chemical abortion by requiring in-person assessment and ultrasound before the prescribing of mifepristone and misoprostol
