About My Pregnancy
Was my ectopic pregnancy a healthy baby?
In an ectopic pregnancy, there is often a pregnancy sac but, in more than 90% of ectopic pregnancies, the fetus has never been viable and there has never been a heartbeat. This is because, as the egg has implanted in the wrong place, it is unable to source a good blood supply and, as a result, the pregnancy cannot grow properly into a healthy baby.
For many, ectopic pregnancy is the loss of their baby and is as emotionally traumatic as any other pregnancy or baby loss experience. The gestation does not matter. It is not possible to move an ectopic pregnancy.
What happened to my pregnancy when treated with methotrexate?
It should first be said that, in ectopic pregnancy, because the egg has implanted in the wrong place, it is unable to source a good blood supply. As a result, the ‘trophoblasts’ (that nourish the embryo and form the placenta) are trying to ‘burrow’ into the walls of the structure the egg is stuck in rather than the uterus and all energy and growth is occurring there. It is these trophoblasts that will eventually cause the rupturing if not treated. This means that our babies are not growing and so, for more than 90% of us, in ectopic pregnancy our babies do not and have ever had, a heartbeat.
Methotrexate is a ‘folate antagonist’. This means it interferes with the folate in our body and causes an essential substance needed to help trophoblast cells to divide to be released from the body. The cells can no longer divide because this essential substance is missing.
Once these cells no longer divide, the pregnancy is ended and the whole pregnancy sac, including any cells that might eventually have grown into a baby, is usually reabsorbed by the mother. This happens because it is our own cellular material and so the body treats it like the reassignment of resources. This is normal and happens in many cases of miscarriage. The ‘reabsorption’ can take weeks and sometimes months to be complete and is monitored through beta hCG blood tests.
In some instances, the Fallopian tube may remain blocked by the pregnancy tissue which can take some time to shrink, and, occasionally, it may not shrink and will leave a blockage in the Fallopian tube by way of a small cyst. However, the use of methotrexate does not reduce the chances of successful future pregnancy, whatever the outcome in the affected tube.
Occasionally, the tissue can separate from the tubal wall and be passed in the blood which is flowing out of the uterine cavity into the vagina.
You may feel pain after being given methotrexate but this is due to the pregnancy sac swelling and not due to effects on the pregnancy.
What happened to my pregnancy when I was treated with surgery?
There are several guidelines for medical professionals to follow regarding the sensitive treatment of your baby. As a result, many hospitals have adopted arrangements with local crematoria for the sensitive disposal of pregnancy remains but they are guidelines, and procedures vary from hospital to hospital.
The detail for these guidelines can be found by clicking each of the links but please be aware that medical terminology like “fetal remains” may be used which some readers may find upsetting:
- Managing the disposal of pregnancy remains
- Disposal of pregnancy remains
- Disposal of Pregnancy Loss Up To And Including 23 Weeks and 6 Days Gestation (Scotland)
- Infant cremation code of practice: third edition (2019)
- National Bereavement Care Pathway resources including Miscarriage, Ectopic Pregnancy and Molar Pregnancy Pathway
For local information about your hospital, you contact the Patient Advice and Liaison Service (PALS) department and ask what the hospital policy is on the sensitive disposal of foetal remains.
The hospital chaplain will do whatever they can to accommodate your needs in relation to your honouring your loss. They will almost certainly have a pregnancy and baby loss service of some kind and you might also like to see what the Baby Loss Awareness Alliance has organised in your area for the next celebrations and acts of remembrance.
Is ectopic pregnancy an abortion?
Ectopic pregnancy is not and never could be regarded as an abortion in the more widely understood meaning of the word where somebody chooses to terminate their pregnancy.
Ectopic pregnancy is a potentially life-threatening condition which, if not medically managed and/or treated, can end the life of the mother. It should not be confused with miscarriage which is not usually life-threatening, or with an elective termination of pregnancy which is a surgical procedure to end a viable pregnancy, or a termination where there is a fetal anomaly.
In over 90% of instances of tubal ectopic pregnancy, the pregnancy has never been growing normally and there has never been or going to be a heartbeat.
Some doctors use the term ‘tubal abortion’ to explain a pregnancy that has miscarried from the Fallopian tube into the abdominal cavity, but most will now say ‘tubal miscarriage’.
There are some rare forms of ectopic pregnancy that can very occasionally result in a livebirth, such as abdominal pregnancy or pregnancy in a rudimentary uterine horn (true cornual pregnancy). However, the risk to the mother’s life is very high due to the risk of sudden rupture and haemorrhage, even in this situation, doctors in the UK will advise surgery to remove the ectopic pregnancy so as to save the mother.