An ectopic pregnancy is one in which the pregnancy does not occur in the womb or inner lining of the uterus. Because of a variety of factors, the pregnancy occurs in the ovary, abdomen or in the fallopian tubes.
Most ectopic pregnancies occur in the fallopian tubes, which have tiny cillia or hairs on the inside that create a wave-like motion to move the egg toward the womb. If there is a blockage or the cillia are damaged, then the fertilized egg can end up elsewhere or remain in the fallopian tubes.
Signs of Ectopic Pregnancy
The signs of an ectopic pregnancy can be manifested in any of three ways:
- A woman suddenly feels ill and collapses. An examination reveals a positive pregnancy test and a ruptured ectopic along with abdominal bleeding.
- Women with a high risk of an ectopic pregnancy include those who have had previous ectopics, had an assisted conception (an IVF is an example), or had tubal surgery. Women in the high risk group should be checked regularly to ensure that an ectopic has not occurred.
- Women with a missed period who present with a positive pregnancy test but have abdominal pain and irregular vaginal bleeding.
Common Causes of Ectopic Pregnancy
Ectopic pregnancies can be cause by a variety of factors including:
- Advanced age
- Pelvic inflammatory disease (PID)--Scar tissue can form following an infection that can damage the cilia in the fallopian tubes. The risk of an ectopic pregnancy increases dramatically after a pelvic infection.
- Tubal surgery--This operation increases the risk of an ectopic. Elevated risks occur as a result of surgeries for a previous ectopic or one that reversed sterilization.
- Prior pregnancy termination--If a woman has terminated her pregnancy two or more times in the past, or suffered an infection afterwards, her risk increases.
- IUD or intrauterine device--If a woman does become pregnant on an IUD, almost half of the pregnancies are ectopic. Intrauterine transplantation is still a possibility.
- Assisted reproductive procedure--This includes an IVF, or test tube birth, or an ovulation induction.
- Tobacco use--Smoking around the time of conception has been known to increase the risk.
- Multiple sex partners or early sexual activity--This increases the incidence of sexually transmitted diseases that can lead to infections, as well as increasing the odds of having a problem pregnancy.
Although some women are able to spontaneously absorb the ectopic with minimal or no complications, the primary risk of an ectopic pregnancy is a rupture leading to internal bleeding, which can be fatal if not treated immediately. Many times a woman’s failure to seek early medical attention can lead to death, but a misdiagnosis can also be fatal.
Other complications include pelvic shock and abdominal pain. When
the fallopian tube ruptures, blood can irritate other tissues and
organs causing intense pain. Scar tissue can form leading to the
increased risk of future ectopic pregnancies, difficulty in becoming
pregnant, or infertility.
A physician who fails to give a complete examination and misses the rupture or internal bleeding may be held accountable for medical malpractice. Any woman of childbearing age who presents with abdominal pain or a missed period should always be checked for the possibility of an ectopic pregnancy. This includes women who have the risk factors discussed above.
Further, women who have had a tubal ligation, or permanent sterilization, need to be informed of the possibility of a uterine pregnancy and that they are subject to ectopic pregnancies. The physician’s failure to inform patients may be actionable in a medical malpractice claim.
Ultrasound, sonograms and measuring hormone levels should be routine, but they also need to be properly interpreted. For instance, a rise in hormone levels with no evidence of embryo implantation in the uterus may be proof of an ectopic pregnancy. The failure to take action can lead to rupture, bleeding, organ and tissue damage, and infertility if not death.
In these situations, the injured woman or her family should consult with an ectopic pregnancy attorney, or medical malpractice attorney, to discuss their legal options.
Treatment for an ectopic pregnancy can consist of administering methotrexate, a drug that dissolves the fertilized egg that the body then absorbs. This is done if the ectopic is not far along, thus preserving the fallopian tube.
Otherwise, a laparoscopy is performed to remove the egg through a small incision at the belly button. This procedure can usually be performed with minimal inconvenience to the patient who can return home the same day and quickly return to normal activities.
If the ectopic is large or ruptured, a laparotomy is performed, which can disable the patient for several weeks. The entire fallopian tube may be removed if it is severely damaged.
Preventable errors during the procedure such as unnecessarily removing the fallopian tubes or damaging them, leaving instruments behind in the patient, or damaging other organs can be grounds for medical malpractice.
Physicians are held to a standard of care that is commensurate with the average competence of a physician in the same area of practice. If it is determined that the physician's failure to diagnose, or that the delay in their diagnosis, deviated from the standard of care expected of a reasonably competent physician, then he or she may have committed medical malpractice.
Nurses are also held to a similar standard of care and competence and can be held responsible if they failed to conduct or to read tests that a nurse of reasonable competence would have done in similar circumstances.
A hospital or clinic that hires and/or trains its staff can also be held accountable for medical errors.
Although an ectopic pregnancy cannot be prevented, a woman can take steps to minimize her risk by seeking early medical attention if she has abnormal vaginal bleeding or abdominal pain, especially if she knows she is pregnant. It is also possible that she could be suffering from an unrelated condition, such as kidney stones, pelvic or bladder infection, appendicitis, or a miscarriage.
Women who are treated early and successfully without rupture to their fallopian tubes can still have successful pregnancies, even though their risk of a future ectopic is increased if they have a second ectopic pregnancy.
Steps to Take
If you or a relative have suffered from internal bleeding from a ruptured fallopian tube that led to organ damage, loss of the fallopian tubes, infertility or even death, promptly consult an ectopic pregnancy lawyer or medical malpractice lawyer.
There is a time limit for filing claims. Therefore, you should contact an experienced medical malpractice attorney if you feel that you have a case.