Are Treatments for Ectopic Pregnancies Affected by the Overturning of Roe v. Wade?

An ectopic pregnancy is a rare, life-threatening complication that requires emergency care. If left untreated, it can cause hemorrhaging and even death. While the majority of treatment options for ectopic pregnancies are termination, new laws in many states banning abortion have created confusion over how to legally treat someone with an ectopic pregnancy. Here's what to know about ectopic pregnancies and how the Supreme Court overturning Roe v. Wade could affect some people's ability to get care. 

What is ectopic pregnancy?

Ectopic pregnancy is when a fertilized egg attaches someplace other than the uterus (where healthy pregnancies occur). Most commonly, ectopic pregnancies occur in a person's fallopian tubes. In rarer cases, ectopic pregnancies can occur in an ovary, the cervix or on C-section scars. These places are not big enough for a baby to grow and develop; therefore, a fertilized egg outside of the uterus rarely survives.  

Ectopic pregnancies make up about 2% of all pregnancies but are one of the top causes of pregnancy-related deaths. They account for 10% to 15% of maternal deaths in the first trimester. Technically, some ectopic pregnancies can resolve on their own, but this is very rare.   

The dangers

Ectopic pregnancies cannot be carried to full term and can be very dangerous. Oftentimes, when a fertilized egg attaches to the fallopian tubes, the growth of the egg can cause the fallopian tubes to burst open and hemorrhage. This major internal bleeding can be fatal if left untreated.  

Ectopic pregnancies are usually detected by six to 10 weeks if there aren't any major signs, such as a rupture. A pelvic exam can diagnose it, as well as a transvaginal ultrasound to determine the place of pregnancy, in addition to a blood test. This life-threatening condition must be treated right away. Delays in seeking emergency medical care increase the risks. 

Signs of ectopic pregnancy

The signs of ectopic pregnancy will, at first, be the same as any pregnancy. These can include swollen breasts, a missed period and nausea. More subtle symptoms may include:

• Mild pain and cramping in the pelvis 
• Abnormal vaginal bleeding
• Lower back pain

While these symptoms mimic a normal pregnancy, there are other signs that might signal your pregnancy is ectopic and may have ruptured. According to the American College of Obstetricians and Gynecologists, those severe symptoms include:

• Sudden, stabbing pain in the pelvis
• Shoulder pain
• Sudden dizziness or passing out

It's important to contact your doctor as soon as you experience these symptoms or suspect something is wrong. 

Who is at risk?

There are a few risk factors to be aware of, including:

• If you have had an ectopic pregnancy previously 
• If you become pregnant while using an IUD birth-control device 
• If you have increased inflammation due to an infection like a sexually transmitted infection
• If you have had in vitro infertility treatments or surgery on your fallopian tubes in the past
• If you have scars from any surgeries close to the pelvic area (such as your appendix) 
• If you are a smoker

What is the treatment for ectopic pregnancy?

Doctors are unable to transfer an ectopic pregnancy to the uterus. The only way to treat this potentially life-threatening condition is by removing the tissue with medication or surgery. There is also a chance that the ectopic pregnancy will end in a miscarriage on its own, but this is rare and hard to determine. Doctors typically do not advocate for monitoring for a miscarriage due to the life-threatening complications of ectopic pregnancies.

Medication management 

Methotrexate, a chemotherapy drug, is administered via injection. The chemotherapy agent will attack and stop cell growth, and the body will absorb the rest. This method is often given to women who have caught the ectopic pregnancy early and have not experienced any internal bleeding. Your doctor will continue to run blood tests while on this medication. 

Surgery 

The other option is surgery, especially if the fallopian tube has burst or is already damaged. If it comes to surgery, either the ectopic pregnancy or the fallopian tube must be removed. Doctors attempt to perform minimally invasive surgery first, but depending on severity or how unstable the patient is, they may have to do an open procedure. 

Will you still be able to get treatment?

In the wake of the Supreme Court overturning Roe v. Wade, there are a lot of questions and anxiety surrounding ectopic pregnancies and the abortion bans in several states. It's confusing to determine what constitutes an abortion, especially when dealing with a pregnancy that can't be brought to full-term.

If you have an ectopic pregnancy, can you still be treated? The answer is yes, at least theoretically, since the language surrounding the abortion bans does not specifically name ectopic pregnancy termination as an abortion. Even in states that ban abortions, there are exemptions for people in life-threatening situations, and ectopic pregnancies would fall under this category. In addition, the procedure to end an ectopic pregnancy is not the same as an abortion procedure. 

However, there's still discussion surrounding this issue -- such as whether and how long people might have to wait for a situation to become life-threatening before termination is an option. This debate may confuse patients and doctors.  

What do medical experts say? 

We spoke with two medical professionals about the vagueness and confusion surrounding anti-abortion laws. They both wonder if this uncertainty will interfere with patients' timely access to care.   

"[Ectopic] treatment will end a pregnancy and depending on the language of the law, if abortion is illegal then technically, this would be an abortion. Sometimes, these pregnancies continue far enough to have cardiac electrical activity, commonly referred to as a heartbeat, and so are we able to intervene in those cases?" said Dr. Kristyn Brandi, assistant professor at Rutgers New Jersey Medical School and board chair of Physicians for Reproductive Health. She worries people may have to wait before receiving treatment, despite the fact that an ectopic pregnancy needs to be treated as soon as possible. 

As the laws are written now, ectopic pregnancy treatment is protected under the abortion bans, but it's the legal aspects that medical professionals fear. Brandi worries about doctors not knowing the legal specifics -- like when they are able to intervene and when they can diagnose. "How close to death do we have to get to qualify under 'maternal health' clauses of most abortion bans?"

Dr. Linda Fan, an assistant professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine, also spoke on the nuances of the new laws. "There have been times when you may have misdiagnosed an ectopic pregnancy and given medication for a normal pregnancy," Fan said. "That happens every once in a blue moon, but the problem is that it might be an issue. I'm not sure how that might play out in the minds of medical practitioners -- maybe not wanting to give out the medication at all. With misinformation and panic, I do wonder if this can happen."

Fan also spoke on the type of ectopic pregnancy that occurs on cesarean scars. "C-section scar ectopic pregnancies are becoming more common. Technically, about 20% to 30% can become viable. I think this is where a lot of the nuances are going to be," said Fan. Even if an ectopic pregnancy has a low chance of being brought to full term, doctors might wonder if they are legally allowed to treat it. 

Brandi said, "As a doctor, I would never want to withhold life-saving treatment to check with my lawyer to make sure it was 'OK' legally for me to care for someone. It is really frightening that doctors' hands may be tired and patients may have worse outcomes because of legal concerns."

Fan was more optimistic. "I don't know if there is actual fear," she said. "In an academic medical center, where we can be certain about the diagnosis, I don't imagine this will be a problem. But I don't know what it will be like in states with abortion bans. I would be curious to know."