A tubular pregnancy (also known as a tubal pregnancy or, more commonly, an ectopic pregnancy) occurs in about one out of every 50 pregnancies. The literal meaning of the word ectopic–out-of-place–explains how a tubular pregnancy differs from the norm. While in a typical, healthy pregnancy, a fertilized egg implants in the uterus after traveling through the fallopian tube, in a tubular pregnancy, the egg implants outside of the uterus. If the signs of a tubular pregnancy are overlooked, a woman’s health and future fertility can be at risk.
Distinguishing a Tubular vs. Uterine Pregnancy
At first, a tubular pregnancy may not present any differently than any other pregnancy. In fact if you have an ectopic pregnancy, you will often have all the same signs as any other pregnant woman: missed period, tender breasts, nausea, bloating and fatigue. Since the embryo is growing, albeit abnormally, your level of hCG, the pregnancy hormone, will register on a pregnancy test. However, if your hCG levels don’t increase as expected or are low to begin with, this can be a very early indication of a tubular pregnancy.
Detecting a Tubular Pregnancy
If your OB-GYN suspects you may have an ectopic pregnancy, either because of your hCG levels or because your health history puts you at risk, he may order an ultrasound to make sure. A physician can sometimes detect a tubular pregnancy via a pelvic exam (by finding a mass in an ovary or fallopian tube), but an ultrasound allows a clearer view of the uterus and surrounding organs. Depending on how far along you are, he may be able to see the embryonic sac outside of the uterus. However, since it’s very difficult to see a pregnancy on an ultrasound before the fifth or sixth week, you may need to wait for the embryo to grow a little more before being sure.
Early Signs of a Tubular Pregnancy
The embryonic growth that can initially alert you and your OB-GYN to the possibility of an ectopic pregnancy. In a uterine pregnancy, embryonic growth is accommodated by the flexibility of the uterine tissue and muscle. In an ectopic pregnancy, there is no give. As the embryo grows in a tubular pregnancy, it puts pressure on the surrounding organs. If the egg has implanted in the fallopian tube, the tube will begin to stretch and, ultimately, be at risk for rupture. In the first few months (six to eight weeks) of pregnancy, this stretching and pressure often manifests as a sharp pain low down on one side of the abdomen. This pain may or may not be accompanied by intermittent vaginal bleeding and pain with bowel movements.
Late Signs of a Tubular Pregnancy
Unfortunately, many tubular pregnancies are not detected in the first few months of pregnancy, especially if you haven’t been deemed at risk for having one. As the embryo grows larger, it will frequently cause damage to, if not a complete rupture of the fallopian tube. Signs that a rupture has occurred include: light-headedness and fainting (due to blood loss), overall weakness, increased vaginal bleeding, severe abdominal pain and pain in the shoulder (due to blood irritating the nerves). If blood loss and internal bleeding are severe, your belly may get hard and you may have bruising around your belly button–a indication of internal bleeding known as Cullen’s sign.
Causes of a Tubular Pregnancy
While in some cases the cause of an ectopic pregnancy is unknown, in many cases there are risk factors involved. If you have a history of endometriosis or pelvic inflammatory disease, your risk is higher because these two conditions can scar the fallopian tubes, making it difficult for the embryo to travel all the way to the uterus. Other conditions that cause scarring, such as a previous tubular pregnancy or a reversed tubal ligation, also increase the risk of a tubular pregnancy, as do infertility treatments and getting pregnant with an IUD in place. It’s important to note that while having a previous tubular pregnancy may increase your chance of a subsequent ectopic pregnancy, it does not mean you can’t have a normal pregnancy in the future.