- Ectopic pregnancy occurs when an embryo implants outside the uterus. Left untreated, it can be fatal.
- Some doctors say the end of Roe v. Wade may impede them from helping women with ectopic pregnancies.
- Survivors of life-threatening ectopic pregnancies have expressed concern about future care.
In the wake of last week's Supreme Court decision to overturn Roe v. Wade, attention has turned to ectopic pregnancies, which occur when an embryo implants outside the uterus. Some people fear that abortion bans in 13 U.S. states might lead to doctors there being unable to treat such pregnancies, which can be fatal.
Ectopic pregnancies, which usually occur in the first five to eight weeks of a pregnancy, are typically the result of an egg attaching to the uterus while still in the fallopian tubes. They can also occur in the cervix, ovaries and abdominal cavity. It's unclear how many occur annually, but experts estimate that they represent roughly 5 to 20 of every 1,000 pregnancies in the U.S.
"They're never viable pregnancies," said Dr. Molly McBride, an OB/GYN in New York. But they can be dangerous: if one of the fallopian tubes ruptures, "it's a medical emergency" because of the resulting loss of blood.
Generally, a woman experiencing an ectopic pregnancy will receive a shot of methotrexate, which "works to dissolve an ectopic," ending the pregnancy, McBride explained.
While the 13 states that currently have abortion bans in place all make exceptions for conditions that endanger the life of the mother, some abortion advocates say that in practice, doctors may be forced to delay care in order to ensure that they don't lose their medical licenses or incur legal consequences.
"Abortion bans, even those with exceptions for ectopic pregnancy, can generate confusion for patients and health care professionals and can result in delays to treatment," the American College of Obstetricians and Gynecologists writes on its website. "Healthcare professionals should never have to navigate vague legal or statutory language to determine whether the law allows them to exercise their professional judgment and provide evidence-based care."
To show the impact an ectopic pregnancy can have on a pregnant person's health, four women who've undergone surgery for ectopic pregnancies discussed their experience with Insider.
'The nurse said, "We almost lost you"'
When she was 21, Jennifer Lane, a 38-year-old writer from San Diego, had an ectopic pregnancy "that nearly killed me."
A college student studying in New York City for the semester, Lane — who was on birth control at the time — was shocked to discover she was pregnant after she went to the ER for severe pain in her lower abdomen.
Doctors couldn't find the embryo at first, then determined it was in Lane's left fallopian tube. Lane's liver enzyme levels were elevated, so instead of administering the methotrexate shot, doctors had to perform laparoscopic surgery to remove the embryo.
"By the time I ended up in the operating room, my fallopian tube ruptured," Lane said. "I hemorrhaged on the table."
What should have been a 45-minute procedure took several hours, she said. "When I woke up, one of the nurses said, 'We almost lost you.'"
The "brutal" recovery took its toll, physically and emotionally. "It was probably the most excruciating pain of my life," said Lane.
"An ectopic pregnancy that's left untreated is a death sentence," said the mom of one, who also wrote about her experience for Insider in May.
'The pain was so bad, I felt like I was being ripped apart'
"I've had so many ectopic pregnancies, I've lost count," said Yelena Leychik, a 38-year-old mother of three from Brooklyn, New York. She said that she lost track at eight, while her doctor said it was closer to 10. "It's a fact of life."
"After the first one, you're upset and crying," Leychik said, but "after a certain point, we're so used to it. It gets to the point where it's like, 'Ectopic? OK, it wasn't meant to be. Let's go get the injection.'"
After one fallopian tube rupture, Leychik said the pain was so excruciating that she felt like she "was being ripped apart." She had the laparoscopic surgery, experiencing trauma similar to Lane's.
Even the less invasive methotrexate shot is so strong, she said, that it leaves her in a depleted state. "You're exhausted, you're cranky, you're mad – you don't know if it's from the pregnancy hormones or from the medication."
Leychik's doctors don't know why she experiences so many ectopic pregnancies. Every time she gets a few weeks into a pregnancy, there "simply a lot of praying," she said.
Her experience has taught her that reproductive health shouldn't be taken for granted, even with a wanted pregnancy. "When friends talk about waiting to have kids, I say, 'Don't put it off.' Don't think just because you want one, it's automatically going to happen.'"
'I went into the OR not knowing whether I'd wake up still pregnant or without my reproductive organs'
When Erica Swallow started bleeding in February of this year, she attributed it to a heavy period, or the after-effects of her recent IUD removal. But when the pain got so bad that she had blurred vision and was vomiting, she went to the hospital.
In the ER, Swallow told Insider that she was "crying out," and felt like she was "going to black out."
Doctors confirmed the 36-year-old was pregnant. But the embryo, which was believed to be aged between two and five weeks, was developing in one of her fallopian tubes.
"The doctor said the pregnancy didn't look like it was viable, but asked whether I'd like to keep it if it was," Swallow, a realtor from Springfield, Massachusetts, said. "It was important to me that I was asked my opinion, and I knew I would like to keep my choice" — even though doctors said it could put her ovaries and fallopian tubes at risk.
Hoping to save the pregnancy, "I went in not knowing whether I'd have a baby after this or still even have my reproductive organs," Swallow said.
Doctors operated, but the pregnancy was not viable. They also had to remove Swallow's left fallopian tube.
Swallow, who wrote about the ectopic pregnancy on her blog, said she felt lucky to be alive. "It's frightening."
'People have bled out and died from an ectopic pregnancy'
When she experienced five weeks of sustained cramping and bleeding in the fall of 2018, Sarah Myerson said she believed her doctors' diagnosis: a prolonged miscarriage.
But when her OB/GYN saw that her levels of the pregnancy hormone hCG were increasing, she had an ultrasound that revealed a "giant cyst" on one of her ovaries. "She thought it was about to rupture, so I needed it to be removed immediately," said Myerson, a 34-year-old cantor in Brooklyn, New York.
The hospital surgeon suspected an ectopic pregnancy — a condition that Myerson said she "had never heard of." In an emergency operation, doctors removed her pregnancy, the cyst and the fallopian tube that had contained the embryo.
Myerson told Insider that she was worried that states banning abortion might cause problems for doctors prescribing methotrexate, which could be considered in the same class as treatments for elective terminations.
"It would be insane if ectopic pregnancies can't be medically treated, and you have to wait until it's a life-threatening emergency and you're coding on the floor for surgery," Myerson said.