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Ectopic Pregnancy: Beyond The Fallopian Tubes

by — Last updated: 2017-01-24 in Pregnancy

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Thought "ectopic pregnancy" only refers to pregnancies that develop within the fallopian tubes? Think again! Ectopic pregnancies can take place within every structure of the reproductive system, and even outside of it.

The terms "tubal pregnancy" and "ectopic pregnancy" are mostly used interchangably — even often by medical professionals. They aren't the same by any means, however. While a tubal prenancy is one that develops in a fallopian tube, an ectopic pregnancy can develop in a wide variety of places, ranging from the ovaries to the cervix, and even the bowels! The vast majority of ectopic pregnancies are not viable by definition, and often become life-threatening for the mother if left untreated as well. Interestingly enough, though, some babies do survive an abdominal pregnancy! 

Tubal Pregnancy

A tubal pregnancy is one that develops in one of the fallopian tubes. A pregnancy can develop within one of the fallopian tubes because the tube in question is blocked or damaged, by pelvic inflammatory disease, previous surgery, a side effect of tubal ligation or endometriosis, but tubal pregnancies can also strike women with healthy fallopian tubes. Except for ovarian pregnancies and those achieved by IVF, all pregnancies pass the fallopian tubes. It's no surprise that tubal pregnancy is the most common type of ectopic pregnancy, and the most talked-about, by far, then.

Interestingly enough, there are actually different types of tubal prenancy, categorized by the location where the fertilized egg implants itself:

  • The egg attaches to the ampullary section of the tube in about 80 percent of all ectopic pregnancy cases.
  • The egg attaches to the isthmus, closer to the uterus, in about 12 percent of cases.
  • In about five percent of ectopic pregnancy cases, the fertilized egg will implant within the fimbrial end of the tube, which its its very end — so away from the uterus.
  • It's rarer for eggs to implant within the cornual and interstitial parts of the tube, and this is seen in about two percent of cases. Because this part is close to the uterus, this type of tubal pregnancy may be missed on an ultrasound scan. 
Tubal pregnancies that develop within the cornual and interstitial part or the isthmus are most risky, due to the increased amount of blood vessels in these areas. In the cases of prenancies that develop within the cornual and interstitial parts of the tube, the fetus can also develop further before symptoms become apparent. A rupture can affect not just the tube, but also the uterine wall. 
 
Tubal pregnancies aren't viable. The fetus naturally stops developing in about half of all cases, while surgery or treatment with Methotrexate, which ends and expels the prenancy, is needed in the remaining cases.

Abdominal Pregnancy

How can a fetus develop inside the abdominal cavity, attached to organs such as the intestines? Surprising as it may be, it happens sometimes. Most likely, such pregnancies start off within a fallopian tube and then float into the abdominal cavity, where they can reattach. Abdominal pregnancies may be missed on routine ultrasound scans because they are found in the expected location, often under the uterus. While such prenancies are very risky indeed, there are instances in which babies that developed within the abdominal cavity survived. 
 
The truth about the pregnancy's location may not be discovered until much later on — in the case of Millie-An Pittman from the UK, doctors only found out she was "in the wrong place" after they had already started performing a c-section. Thankfully the baby was fine: though her mom lost 12 pints of blood and needed emergency surgery, Millie-An weighed a very respectable 8lb 7oz.
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