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July 1, 2022

Inside the post-Roe confusion around ectopic pregnancy treatments

Daily Briefing

    Following the Supreme Court's decision to overturn the 1973 Roe v. Wade and 1992 Planned Parenthood v. Casey decisions, health care providers around the country are asking how the ruling will impact access to treatments for potentially life-threatening conditions, like ectopic pregnancies, Catherine Pearson reports for the New York Times.

    Check out our new resource page for post-Roe implications for health care

    What is an ectopic pregnancy?

    An ectopic pregnancy occurs when a fertilized egg implants outside of a pregnant person's uterus instead of attaching to the uterine lining, where it can survive.

    In roughly 90% of ectopic pregnancies, a fertilized egg implants in one of a pregnant person's fallopian tubes—which connect the ovaries to the uterus. Notably, fallopian tubes are very thin and full of blood vessels. When a fertilized egg starts to grow inside the tube, the tube may burst open, causing major internal bleeding.

    While most ectopic pregnancies occur in the fallopian tubes, fertilized eggs can implant elsewhere in rare cases, including the ovary, cervix, or a previous Cesarean-section scar.

    According to national estimates based on hospital and insurance records, ectopic pregnancy is rare, making up between 1% and 2% of pregnancies in the United States.

    Even though an individual with an ectopic pregnancy may receive a positive pregnancy test, ectopic pregnancies are never viable, noted Beverly Gray, an associate professor in the department of obstetrics and gynecology and founder of the Duke Reproductive Health Equity and Advocacy Mobilization team.

    Ultimately, a fertilized egg is not capable of surviving outside of the uterus. "There is no way to reimplant them," Gray explained. "There is no way that pregnancy will survive."

    In addition, when a fertilized egg implants in a fallopian tube, it becomes life-threatening. "I sort of think of it as a ticking time bomb," Gray said, adding that the condition is typically diagnosed between the fifth and eighth weeks of a pregnancy. "This is a pregnancy that as it continues to grow will cause the tube to rupture and cause basically uncontrolled bleeding."

    How are ectopic pregnancies treated?

    According to Aileen Gariepy, director of complex family planning at Weill Cornell Medicine, the body will—in rare cases—purge an ectopic pregnancy on its own. However, for most women, "the only options are medication to remove the pregnancy or surgery," Pearson writes.

    If an ectopic pregnancy is detected early—within a few days or weeks of the egg implanting—doctors typically prescribe a medication known as methotrexate, which stops cell growth and terminates the pregnancy.

    Another option for early treatments is laparoscopic surgery, in which a doctor either removes the pregnancy alone, or the pregnancy and the fallopian tube.

    However, if the pregnancy continues to develop, it can rupture the fallopian tube, resulting in heavy, life-threatening bleeding. If this occurs, emergency surgery is necessary.

    Will SCOTUS' ruling impact access to ectopic pregnancy treatments?

    Currently, 13 states have enacted laws that ban or will soon ban abortion. But according to Planned Parenthood, "[t]reating an ectopic pregnancy isn't the same thing as getting an abortion."

    "Abortion is a medical procedure that when done safely, ends a pregnancy that's in your uterus. Ectopic pregnancies are unsafely outside of your uterus (usually in the fallopian tubes), and are removed with a medicine called methotrexate or through a laparoscopic surgical procedure. The medical procedures for abortions are not the same as the medical procedures for an ectopic pregnancy," the organization says on its website.

    However, many health care providers have said the recent ruling has raised questions about their ability to treat ectopic pregnancies.

    The American College of Obstetricians and Gynecologists warned that abortion bans—even those that grant exceptions for life-saving treatments—can result in confusion for patients and providers, potentially blocking or delaying a patient's access to care.

    Gariepy agreed that these concerns are likely on doctors' minds. "That confusion is really scary to a lot of people who don't know what to do, or whether or not they can treat ectopic pregnancies," Gariepy said.

    Still, federal law currently requires HHS programs to provide abortion medications in certain circumstances, when the life of a mother is at risk or for pregnancies that result from rape or incest, and HHS Secretary Xavier Becerra said it is "imperative" that all programs comply with these practices.

    Ultimately, Gariepy noted, "As doctors, our job is to follow science and evidence-based medicine, it is keeping up-to-date and doing what's right for the patient. It is not the nuances of how state legislatures wrote something." (Pearson, New York Times, 6/28; Planned Parenthood, accessed 6/30)

    The business implications of overturning Roe v. Wade

    Access our new resource library

    physiciansThe recent Supreme Court ruling on Dobbs v. Jackson Women’s Health Organization has triggered a cascade of uncertain consequences for health care leaders and the patients they serve.

    Going forward, our research teams will be updating this new resource page with helpful analysis and deep dives, including: 

    Access now

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