Ectopic pregnancy and the abortion ruling, explained

Critics of the Supreme Court reversal of Roe v. Wade warn that it may affect patient access to life-saving treatment for a condition called ectopic pregnancy.

An ectopic pregnancy is one in which the fertilized egg grows outside the uterus — typically inside one of the fallopian tubes, where a fetus cannot survive. The condition also can be fatal for the pregnant person, if the pregnancy is not terminated with medication or surgery.

These procedures are not considered to be abortions, but patients may have a hard time getting them in states where abortion restrictions are vaguely worded, the American College of Obstetricians and Gynecologist says.

The details vary by state, but depending on how the laws are interpreted by hospitals, the result can be confusion, delay, and harm to patients, said Greer Donley, an assistant professor at the University of Pittsburgh School of Law.

Here’s a breakdown of ectopic pregnancy and how it is affected by law.

When all goes well, a fertilized egg travels along the fallopian tube to the uterus, where it implants in the uterine wall and grows into a fetus.

In 1% to 2% of cases — more than 100,000 times a year in the U.S. — the fertilized egg goes astray: the definition of an ectopic pregnancy.

In most of these cases, the fertilized egg implants in the fallopian tube. It also can end up in the ovary, cervix, or abdominal cavity.

A variety of medical conditions and patient characteristics are associated with an increased risk of ectopic pregnancy, the obstetricians college says.

One of the primary predictors is having had an ectopic pregnancy in the past. If you survive the condition, chances are higher that in a future pregnancy, it will happen again.

Other risk factors include: previous pelvic, abdominal, or fallopian-tube surgery; certain sexually transmitted infections; pelvic inflammatory disease; and endometriosis.

The following traits may also increase a woman’s risk of ectopic pregnancy: cigarette smoking; being over 35; a history of infertility; and the use of in-vitro fertilization.

Yet close to half of women with an ectopic pregnancy have no known risk factors.

Some of the early signs of ectopic pregnancy are hard to distinguish from the normal aches and pains that arise when carrying a fetus.

Possible signs include abnormal bleeding and pelvic pain. Tell your healthcare provider if either of those symptoms occurs.

Later in an ectopic pregnancy, possible warning signs include sudden severe pain in the abdomen or pelvis; sudden shoulder pain; and sudden weakness or dizziness. Those symptoms warrant a trip to the emergency room, as they can mean a ruptured fallopian tube, the obstetricians college says.

In some cases, ectopic pregnancies terminate on their own, according to the American Society for Reproductive Medicine. In others, the physician may prescribe medication.

If the pregnancy is far enough along, as determined by an ultrasound exam, surgery may be the only recourse.

Without prompt treatment, the pregnant person can suffer severe internal bleeding, even death.

No approved state restrictions on abortion explicitly forbid treatment for ectopic pregnancy, said Donley, who specializes in reproductive health law.

But the vague language in some laws has prompted hesitation among patients and even some physicians, leading to potentially harmful delays, she said.

Here’s how that could happen.

In states with stringent abortion restrictions, the law commonly includes a “life exception.” That is, physicians are still allowed to terminate a pregnancy in an emergency situation — generally, when the life of the pregnant person is at stake.

But in states with restrictive laws, some healthcare providers have interpreted them to restrict surgery for ending an ectopic pregnancy. That leaves the question of what constitutes an emergency, Donley said.

“Some have interpreted the life exception to mean waiting until the fallopian tube ruptures,” she said.

Depending on how soon the person can get emergency care, that might be too late.

“Sometimes I have anti-abortion people that say to me their laws are never intended to cover ectopic pregnancy,” she said. “It doesn’t really matter, because there’s so much confusion about when the life exception is invoked, that people are delaying care and threatening the life of the patient regardless.”

In a case described last fall by The Lily, a publication for millennial women that has since folded into the Washington Post, a Texas woman with an ectopic pregnancy was turned away by physicians in her home state.

One physician was “nervous” about being sued, citing state law, the woman told advocates for abortion access. The woman then called an emergency room, which advised her to seek care in another state, the media outlet reported. She drove more than 12 hours to New Mexico, where she successfully underwent surgery to terminate the pregnancy.