Ectopic pregnancy

For what it's worth, if anything, here are some of my thoughts on the topic of ectopic pregnancy:

1. Keep in mind I'm a mere med student, not a physician, let alone an OB/GYN. I'm open to correction on the medical science and other related data.

2. The vast majority of ectopic pregnancies are tubal ectopic pregnancies. Specifically, 95-98% of all ectopic pregnancies are tubal ectopic pregnancies. This simply means they're in one of the Fallopian aka uterine tubes.

   Other types of ectopic pregnancies are far less common (e.g. ovarian, cervical, abdominal).

3. My understanding is if an ectopic pregnancy occurs (e.g. the embryo implants in one of the uterine tubes), then there are basically two possibilities:

   a. The pregnancy will end in miscarriage.

   b. The baby will grow too big and rupture the uterine tube. This may in turn damage adjacent organs. Worse, the rupture could likewise cause the mother to hemorrhage to death.

4. If ectopic pregnancy is discovered early on, and doctors think (a) is most likely, then doctors will attempt what's called "expectant management." This means the doctors will closely monitor the mother and hope the pregnancy will naturally resolve itself in a miscarriage. That way, nothing much needs to be done by the medical team, and the health outcomes for the mother are probably best (e.g. she'll still likely be fertile).

   But if (b) is more likely, then medical (in the form of an abortifacient drug i.e. methotrexate) and/or surgical intervention is needed. It could be a medical emergency depending on how close to rupturing it is.

5. A few possible if currently perhaps unrealistic pro-life options:

   All these assume the baby in the ectopic pregnancy is developing normally or at least not developing too abnormally. This may be a pretty big assumption though. It's quite possible the baby won't be developing normally. Not getting enough blood and nutrients from the mother and so on since it's not implanted in the mother's womb but outside it (by definition).

   a. A potential option is to surgically transplant the embryo from the uterine tube (or wherever else it is) to the uterus aka womb.

   However, at least to my knowledge, medical science isn't advanced enough to do this let alone do this safely.

   Maybe someday in the future.

   b. Another possible option is to allow the ectopic pregnancy to grow and develop as much as possible, and then to surgically remove the baby as a preemie.

   However, this is highly unrealistic in a tubal ectopic pregnancy. The diameter of the uterine tube is approximately half an inch or thereabouts (about 1.25 cm). While the uterine tube is extensible to some degree (depending on several factors), the bottom line is if the baby grows too much bigger than the diameter of the uterine tube, then it could rupture the tube, and put the mother's life at risk. The baby would already be about half an inch at around 6 weeks. By 8 weeks or so, the baby would have doubled this size. At this point, or not too much beyond this point, it's possible the uterine tube could be at grave danger of rupturing. But to remove the baby at even 10-12 weeks would mean it'd die.

   Currently the earliest we've been able to save babies is around 20 weeks, give or take. And that's extremely rare. Most don't make it.

   But maybe future medical technology will make this a viable option.

   c. In the vast majority of ectopic pregnancies (i.e. tubal ectopic pregnancies), unfortunately it seems the best option is either to allow the ectopic pregnancy to naturally end i.e. miscarriage, or to intervene and abort. This is where some philosophers and ethicists justify the abortion by the doctrine of double effect. But in a small percentage of ectopic pregnancies, it may be possible to save the baby and/or mother. Basically, my understanding is these are in general only realistic in abdominal ectopic pregnancies, although there may be some cases where it's happened in other types of ectopic pregnancies.

   If the ectopic pregnancy is in the abdomen, then there might be more room as well as sufficient blood supply (depending on where in the abdomen the baby is) for the baby to grow and develop and with some luck make it to 20+ weeks, and thus we could hope to remove the premature baby such that neonatologists have a fighting chance to work their magic and rescue the baby. Although even 20+ week old babies are still at huge risk of dying. (A full-term pregnancy is at least about 37 weeks.)

   But even still there's absolutely no guarantee both baby and mother won't die. I think it'd be best to look at abdominal ectopic pregnancies on a case by case basis and see what, if anything, can be done to save both, or one (if not both).

   Here is a list of some successful ectopic pregnancies. But note the vast majority of them (if not all of them) are abdominal ectopic pregnancies, not tubal ectopic pregnancies (which again constitute the vast majority of all ectopic pregnancies - i.e. 95-98%).