Ectopic pregnancies are back in the news, as many wonder how state abortion bans will affect people carrying ectopic pregnancies, now that Roe v. Wade has been overturned.
Though many "trigger bans" affecting abortion access make exceptions for ectopic pregnancies, the American College of Obstetricians and Gynecologists (ACOG) has expressed concern over how bans may confuse caregivers and patients.
"Health care 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," they wrote.
"Patients with an ectopic pregnancy must have timely access to all treatment options."
When it comes to ectopic pregnancy, fast medical action is often necessary. Delays, ACOG warns, can be deadly for people with the condition.
Ectopic pregnancies have made headlines before; in 2019, a bill in Ohio was introduced that would prohibit most insurance companies from covering abortions, but when the representative who sponsored the bill suggested that ectopic pregnancies can be re-implanted in the uterus, many people spoke up on social media to clarify that, well, that's not actually a medical possibility.
But first, what is ectopic pregnancy?
An ectopic pregnancy occurs when a fertilized egg grows somewhere outside the uterus — in 90% of cases, in one of the fallopian tubes.
"One of the things that I always try to explain to women is that this is not a baby," Dr. Donnica Moore, a gynecologist and women's health expert, told TODAY Parents. "This is a pregnancy that did not implant in the womb and it can't be saved."
Ectopic pregnancies, also commonly known as tubal pregnancies, can cause dangerous complications, including internal bleeding or a ruptured fallopian tube.
"The fallopian tube is very narrow, so by the time the implantation is big enough that it's causing a blockage of tubes, you'll usually have symptoms," Moore said.
Risk factors for ectopic pregnancies include having had one in the past, having had pelvic inflammatory disease or any type of damage or scarring on the fallopian tubes, being a cigarette smoker and being older than 35 years old. Women who use assisted reproductive technology, including IVF, also have a greater risk of having an ectopic pregnancy. That said, half of women with ectopic pregnancies have no risk factors.
Ectopic pregnancy symptoms
An ectopic pregnancy often feels like a typical pregnancy in the beginning, with symptoms including mild cramping, breast tenderness and nausea.
But if the cramping is severe and only happening on one side of the body, that could signal an ectopic pregnancy.
"Usually women (with ectopic pregnancies) complain of a more constant pain," said Dr. Meera Garcia, assistant professor of obstetrics and gynecology at Columbia University Irving Medical Center in New York. "It seems a little more than the premenstrual, menstrual-like cramping that most people have."
"A lot of time if there's a pregnancy in the left fallopian tube, for example, women will feel it in that side. They might even come in and point to where the pain is and say, 'It feels like my ovary hurts.'"
Other symptoms include abnormal vaginal bleeding, pelvic pain and low back pain.
Most women are diagnosed with an ectopic pregnancy early on, usually between six and 10 weeks.
"It's very unusual for women to get past 12 to 14 weeks without knowing where the pregnancy is located, because most women will have had an ultrasound by then," said Dr. Shannon Clark, an associate professor of Maternal Fetal Medicine at the University of Texas Medical Branch in Galveston.
Ectopic pregnancy treatment
There are two ways to treat an ectopic pregnancy: medication and surgery.
An early ectopic pregnancy is usually treated with a medication called methotrexate, which kills the cells.
A later pregnancy is typically treated with surgery, either a laparoscopic surgery or an open abdominal surgery.
"If it's a worst-case scenario and (the tube) has ruptured, symptoms will be more severe — nausea, vomiting, abdominal pain. Women may be dizzy," Dr. Clark said. "That's a more acute surgical situation."
Unfortunately, it is not possible to "re-implant" an ectopic pregnancy in the womb. Dr. Daniel Grossman, a California OB-GYN who spoke about up about the Ohio bill on Twitter, called the idea that someone could move an embryo from the fallopian tube to the uterus "pure science fiction."
"We just don't have the technology," he wrote.
'There is joy and there is pain'
While ectopic pregnancies are rare, TODAY's Jenna Bush Hager has talked about hers, before she had Mila, her 9-year-old daughter.
"I was so excited ... I got to the doctor's office and she said, 'Yeah, you're pregnant, but we can't find the baby,''" Jenna said during a conversation with Meredith Vieira about their respective journeys to parenthood. "And I had no idea what an ectopic pregnancy was. The (pregnancy) was in my fallopian tube."
"My husband was out of town. My sister was in Africa. So I went into emergency surgery and I had my fallopian tube removed," she added, calling the experience "isolating."
The important thing to know is that women who have ectopic pregnancies can absolutely go on to have healthy pregnancies.
Jenna, now a mom of three, hopes that sharing her story gives others hope.
"The point of this all is that there is joy and there is pain and for Dylan to share her pain with all of us hopefully brings us all the hope that there will be joy," she said.
This story was originally published in 2019 and has been updated.