What the overturning of Roe v. Wade means for ectopic pregnancy and how to get the care you need
- An ectopic pregnancy can be fatal, and doctors need to end it right away to prevent organ rupture.
- Post-Roe v. Wade, abortion bans may keep doctors from providing timely, necessary care.
Since the Supreme Court ruling of June 24, 2022 that overturned Roe v. Wade, many states have banned abortion, or severely restricted abortion access.
As many healthcare experts have already pointed out, these bans and restrictions could have serious health consequences for pregnant people — especially people with ectopic pregnancy, a condition where the fertilized egg lodges outside the uterus.
It is impossible for an ectopic pregnancy to develop into a viable fetus, since only a uterus can carry an embryo to term. But ectopic pregnancy can be fatal if not addressed quickly, and the treatment involves ending the pregnancy.
In states that have now banned or limited abortions, it's become more difficult, if not impossible, to obtain timely treatment, with "timely" meaning removing the fertilized egg before it grows large enough to rupture an organ. Doctors fear these new restrictions will put many people in danger.
In the news: On July 8, 2022, President Biden signed an executive order to expand access to abortion care. This order protects medication abortion, along with patient privacy. It's also designed to help pregnant people access emergency healthcare, which may extend to ectopic pregnancy treatment.
Why ectopic pregnancy is so dangerous
In over 97% of ectopic pregnancies, the egg gets stuck in your fallopian tubes as it travels between your ovaries and uterus. That's why it's often called a tubal pregnancy. However, the egg can get stuck elsewhere in your body, including your ovaries, cervix, or scars from a previous Cesarean section.
Contrary to the musings of Ohio Representative John Becker, it is not possible to detach a fertilized egg from your fallopian tubes and reimplant it in your uterus. Once an egg lodges in your tissue, it will grow there, and only there.
Once a tubal pregnancy grows big enough, it will likely tear your fallopian tube open. As blood spills into your abdomen, your blood pressure will drop. Without prompt treatment, you could die of hemorrhage, sepsis, or organ failure.
Even with the advances of modern medicine, ectopic pregnancies cause 6% of pregnancy-related deaths, according to research from 2015.
Is organ rupture preventable?
Best practices have doctors treat ectopic pregnancy as soon as it is detected. The first line of treatment is often a medication called methotrexate, which halts cell growth and tells your body to absorb the remaining tissue. If you can't take methotrexate due to liver disease or some other issue, surgery is also an option.
Early treatment can end the ectopic pregnancy before it damages your organs or puts your life at risk.
Once an organ ruptures, however, a surgeon may have to remove the remains from your body. If you lose a fallopian tube or ovary, that could affect your future fertility.
Does the overturning of Roe v. Wade affect ectopic pregnancy treatment?
By overturning Roe v. Wade, the Supreme Court ruled that abortion was not a consitutional right.
While abortion remains legal in federal law, states now have the option to completely ban abortion within their borders, except in life-or-death situations.
Is ectopic pregnancy removal considered abortion?
"Some people say that these laws don't cover ectopic pregnancy, since the embryo isn't viable, but that's not true. In these laws, the definition is to end a pregnancy, and even though the ectopic tissue is outside the uterus, it's still a pregnancy," says Dr. Louise P. King, surgeon and Director of Reproductive Bioethics at Harvard Medical School Center for Bioethics.
"We in the medical field consider ectopic pregnancy treatment to be abortion. The law considers it abortion," King says.
Some states, such as Oklahoma, only count ectopic pregnancy removal as abortion if doctors can detect electrical activity through a fetal doppler. This is referred to as a "heartbeat," even though the heart hasn't fully developed yet. Not all ectopic pregnancies will have electrical activity — some estimates suggest as few as one in 20 cases develop a detectable "heartbeat."
Other states, like Missouri, don't list a detectable "heartbeat" as a criterion, so ectopic pregnancy removal is considered abortion.
How do these bans affect treatment?
According to these laws, doctors are no longer allowed to prescribe methotrexate to end the ectopic pregnancy. Removing the embryo or fetus when a patient is still stable would be considered an illegal, non-emergency abortion.
This leaves invasive surgery as your only treatment option in states that ban abortion. And doctors aren't allowed to perform said surgery until one of two things occur:
- If the ectopic pregnancy developed electrical activity, doctors must wait for that "heartbeat" to stop. This signals the embryo or fetus has died.
- You are actively dying yourself.
Delayed ectopic pregnancy treatment isn't a hypothetical concern
The Texas Policy Evaluation Project (TxPEP) surveyed clinicians on the effects of Texas's abortion ban in 2021. The researchers heard multiple reports of doctors sending people with ectopic pregnancies home without treatment, for fear of breaking the law if they ended a pregnancy too early.
"Physicians are making decisions about the care of pregnant people based on fear of legal repercussions rather than providing evidence-based care," says Whitney Arey, PhD, one of the TxPEP researchers.
Note: Earlier this year, Missouri legislators proposed a bill that explicitly banned abortion for ectopic pregnancies, making any attempt at treatment a Class A felony. The Missouri House of Representatives shot it down, but the bill has been put on what's called an informal perfection calendar, where it may be edited and resubmitted at a later date.
Why delaying treatment can be dangerous
Waiting until a patient is in crisis can be extremely dangerous. According to King, there's no way to predict exactly when an ectopic pregnancy will rupture your organs or how bad the damage will be. Depending on how much you're bleeding, doctors may have only minutes to save your life.
"This is not how we practice medicine," King says. "We anticipate problems. We prevent them. We don't wait until the patient is already in crisis before treating them."
Delayed care increases your likelihood of health complications from ectopic pregnancy such as:
- Internal bleeding throughout the body, which could cause heart, lung, or liver failure
- Sepsis, a severe immune reaction to infection
- Destruction of the fallopian tube, uterus, or other reproductive organs
Abortion can save lives in other circumstances, too
Ectopic pregnancy isn't the only life-threatening condition for which someone might need abortion. According to TxPEP, Texas clinicians have also been reluctant to provide abortion care for patients with:
- End-stage kidney disease
- Heart disease
- Severe hyperemesis gravidarum (uncontrollable vomiting)
Ectopic pregnancy treatment vs. abortion
Most ectopic pregnancies are detected and treated in the first trimester.
In some cases, the ectopic pregnancy may resolve on its own, with the body reabsorbing the tissue. Most of the time, though, this condition requires medical intervention.
Here's a rundown of how they're different:
|Ectopic pregnancy||Pregnancy in uterus|
|A healthcare professional will administer methotrexate as an injection. Guidelines recommend injecting methotrexate before the fetus reaches 4 cm in size or one of your organs ruptures.||You can take a combination of two pills, mifepristone and then misoprostol, within the first 70 days of gestation, or 10 weeks from the first day of your last period.|
|Methotrexate halts cell growth and tells your body to absorb the remaining tissue.||Mifepristone blocks the hormone progesterone, which is necessary for pregnancy growth. Misoprostol causes your uterus to contract and empty its contents, similar to a period.|
|You may have mild cramping for three to seven days. You can also expect some light vaginal bleeding.||You may have severe cramping and bleeding in the first few hours after taking misoprostol. The pain and bleeding should diminish within 24 hours.|
|Methotrexate can stop cell growth in four to seven days, though sometimes it takes longer. Your body could take four to six weeks to fully absorb the remaining tissue.||Beginning with the mifepristone and ending when your uterus is empty, this abortion process may take one to three days.|
|Ectopic pregnancy||Pregnancy in uterus|
|Surgical treatment for ectopic pregnancy is a laparoscopy. In this procedure, the surgeon makes a small cut near your belly button, and then a small incision in your fallopian tube. The surgeon then removes the embryo or fetus.||During the first 16 weeks of pregnancy, the most common kind of surgery is aspiration abortion. This method empties your uterus by applying gentle suction of the tissue in the uterus through your vagina — no incisions needed.|
|Laparoscopy is done with general anesthesia, which means you sleep through the procedure.||It's often done with local anesthesia, meaning you're awake during the procedure.|
|On average, laparoscopy for tubal pregnancy takes 55 minutes.||It usually takes five to ten minutes.|
How to get medical care if you suspect ectopic pregnancy
The symptoms of ectopic pregnancy often show up between the sixth and ninth weeks of pregnancy.
Signs a pregnancy may be ectopic include:
- Abnormal vaginal bleeding
- Pain in your lower back or abdomen
- Cramping on one side of your pelvis
The only way to know for sure if you have an ectopic pregnancy is to visit an OB-GYN or other healthcare professional. Your doctor will likely do a blood test to check your levels of HCG, the pregnancy hormone. Once they confirm the pregnancy, they can then use an ultrasound to determine where the egg is in your body.
Again, an ectopic pregnancy may or may not have a fetal heartbeat.
According to the Planned Parenthood State-By-State Guide, updated after the overturning of Roe v. Wade:
- South Dakota, Missouri, Arkansas, Texas and Alabama outlaw abortion at any point.
- Oklahoma outlaws abortion after fertilization.
- Ohio, Tennessee, and South Carolina outlaw abortion once doctors detect electrical activity. This "heartbeat" often appears around the sixth week of pregnancy.
Remember, the signs of ectopic pregnancy often don't show up until the sixth week of pregnancy — and doctors count the first week of pregnancy from the first day of your last menstrual period.
Depending on the state you live in, you may already have limited options for treatment. The hospital may say your condition needs to worsen before they are allowed to perform surgery.
Unfortunately, there's no official guidance for what you should do next. Should you wait at home? Try another hospital? Travel to another state?
Here are some things to consider when making your decision:
- How far are you from a state that permits abortion? Shorter trips are less risky than long ones, especially when you're faced with the possibility of organ rupture.
- How long have you been pregnant? The further the pregnancy has advanced, the more dangerous the organ rupture may be when it happens. Surgery also becomes more difficult when the tear is larger.
- How severe are your symptoms? Your pain and bleeding will likely worsen as the ectopic pregnancy progresses. Higher pain levels may be a sign to stay close to the hospital.
Signs of an organ rupture include:
- Weakness, dizziness, or fainting
- Sudden, severe pain in your abdomen or pelvic area
- Shoulder pain
If you have any of these signs, you need to get to an emergency room immediately. Don't worry about whether it's a "false alarm" or if you're being impatient. Just go. The quicker you get treatment, the better your chances of survival.
Remember, these bans make it illegal to perform an abortion, but it's still legal to request one. You personally cannot be held criminally liable for asking your doctors to perform the abortion. You may need to visit your doctor multiple times before they provide care.
When it comes to ectopic pregnancy, it's better to err on the side of caution and seek help as quickly as possible, especially if you experience pain and bleeding that continues to worsen.
If you need an abortion, you don't have to figure everything out on your own. Many organizations that help fund abortion around the country can offer assistance by:
- Helping you safely travel between states
- Defraying childcare costs
- Providing emotional support
You may want to check out the following regional abortion funds:
- Access Reproductive Care - Southeast: Serves Alabama, Florida, Georgia, Mississippi, South Carolina, and Tennessee
- Midwest Access Coalition: Serves Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin
- Northwest Abortion Access Fund: Serves Alaska, Idaho, Oregon, and Washington
If your state isn't served by one of the larger funds above, don't despair. Some states, like Utah or Texas, have their own specific programs. You can find a full list of organizations at the National Network of Abortion Funds.
Ectopic pregnancies can easily become fatal without prompt treatment.
Unfortunately, while state abortion bans allow exceptions for emergencies, their definition of "emergency" remains so narrow that doctors have to delay treatment until the last minute. This can force people into life-or-death scenarios that could easily be prevented with timely care.
Furthermore, the laws around abortion are changing rapidly state by state, making it hard to know which interventions are still legal.
If you suspect ectopic pregnancy, make an appointment with a doctor or clinician right away. Once they confirm the ectopic pregnancy, they can offer more guidance on next steps and getting the care you need.
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