- Strict abortion restrictions and bans may affect quick access to ectopic pregnancy treatment.
- An embryo has "no chance of survival" in an ectopic pregnancy, and delayed treatment can kill women.
- An abortion isn't the same, medically, as ectopic pregnancy treatment.
When Jennifer Lane went to the ER at age 21 with excruciating abdominal pain, she didn't know she was pregnant.
But doctors quickly discovered she was — and that the fertilized egg had implanted in her fallopian tube, rather than her uterus. The complication is called an ectopic pregnancy, and explained Lane's unbearable pain.
Swift treatment was critical, since the pregnancy tissue can rupture the fallopian tube, leading to internal bleeding and possibly death. But Lane's treatment was delayed because it had to be performed on an empty stomach, leading her fallopian tube to burst during surgery.
"We almost lost you," a nurse told her when she awoke. "It wasn't until hours later that I realized I'd nearly died," Lane wrote for Insider.
After the Supreme Court overturned Roe v. Wade last month, clinicians and women in many states fear abortion bans and restrictions will kill people like Lane if laws are interpreted to inhibit treatment for ectopic pregnancies.
Ectopic pregnancies are the leading cause of maternal death in the first trimester, usually due to lack of intervention. But an embryo can't survive in the fallopian tube or be transported to the uterus, and there's no medical debate that treatment is the best option.
The longer the wait for treatment, the higher the risk of maternal death. Fetal death is inevitable.
About 2% of pregnancies are ectopic, according to the medical textbook Merck Manual. The vast majority are "tubal," when a fertilized egg gets stuck in the fallopian tube rather than implanting in the uterus, the only place it can grow.
In less than 10% of ectopic pregnancy cases, the fertilized egg implants somewhere other than the fallopian tube, like the abdomen or an ovary.
Tubal pregnancies can happen if your fallopian tube is misshapen or inflamed, or if you have a hormonal balance. Smoking, a prior ectopic pregnancy, and infection like from an STI can also increase the risk, although about half of people who experience ectopic pregnancies have no risk factors, according to the American College of Obstetricians and Gynecologists.
While the pregnancy can sometimes survive for several weeks, it typically ruptures on its own after about six to 16 weeks, "long before the fetus is able to live on its own," the Merck Manual reports. It can't survive outside the uterus because that's the only place in the body it can receive sufficient blood supply and support.
"The later the structure ruptures, the worse the blood loss, and the higher the risk of death," it says. "However, if an ectopic pregnancy is treated before it ruptures, the woman rarely dies."
In extremely rare cases — 1 in 10,000 to 1 in 30,000 — an ectopic pregnancy occurs in the abdomen. While there is one 2011 case study describing a woman in Ghana who delivered a healthy baby after an abdominal pregnancy, chances of fetal survival in such a case are "infinitesimal," Dr. Patricia Santiago-Munoz, an OB-GYN at UT Southwestern Medical Center, wrote in 2019.
"Such cases are virtually nonexistent" in the US, she said, where early ultrasounds are the standard of care. If an abdominal ectopic pregnancy is detected, it's removed to prevent "potential catastrophic bleeding," Santiago-Munoz wrote.
The medical community agrees that ectopic pregnancy treatment is not abortion
To treat an ectopic pregnancy, doctors usually surgically remove the tissue and the part of the fallopian tube that's beyond repair. If it's caught early enough and hasn't ruptured, they may give the patient a medication to dissolve the pregnancy instead.
But the medical guidance is clear: "An ectopic pregnancy must be ended as soon as possible to save the life of the woman," the Merck Manual writes.
Technically, ectopic pregnancy treatment is not the same as an abortion since the medical definition of "abortion" is removal of an embryo and placenta from the uterus. In an ectopic pregnancy, the embryo is not in the uterus, Santiago-Munoz wrote.
Even the American Association of Pro-Life Obstetricians supports timely ectopic pregnancy treatment since "there is no chance for survival of the child either inside or outside the womb," the group wrote in a 2010 position statement, "but there is a very real, imminent danger of death or disability for the mother."
The doctors say their organization "recognizes the unavoidable loss of human life that occurs in an ectopic pregnancy, but does not consider treatment of ectopic pregnancy by standard surgical or medical procedures to be the moral equivalent of elective abortion, or to be the wrongful taking of human life."