Roe v. Wade and Ectopic Pregnancies: Everything You Need to Know

There are lots (and lots and lots) of questions that hang in the balance since the Supreme Court overturned Roe v. Wade and abortion healthcare is no longer a Constitutional right. But abortion is healthcare. In fact, in some cases, like ectopic pregnancies, abortion is lifesaving. No doubt, this is why the topic of Roe v. Wade and ectopic pregnancies has been so prevalent. But what exactly are ectopic pregnancies and what do they have to do with abortion laws? We spoke with OBGYN Dr. Stephanie Hack, MD, and host of Lady Parts Doctor Podcast to learn more.

In a healthy pregnancy, a fertilized egg attaches to the lining of the uterus. An ectopic pregnancy, however, is any pregnancy that implants outside of the uterine cavity.  They occur in approximately 2 percent of all reported pregnancies, most commonly—90 percent of the time—in the fallopian tubes where it cannot survive, Dr. Hack tells us. (This is why it’s often called a tubal pregnancy.)

Per Dr. Hack: “There are very rare cases where the ectopic pregnancy has implanted in the abdominal cavity and survived to term.”  In a report from the Ghana Medicine Journal,

“These pregnancies generally do not get to 37 weeks (term gestation) and usually the end result is the extraction of a dead fetus. Another challenge for babies from abdominal pregnancy is the very high incidence of congenital malformations.” The article also explains that maternal mortality and morbidity are also very high. 

Treatment of ectopic pregnancies depends on a number of factors. “An early ectopic pregnancy in a healthy, stable patient without contraindications, could possibly be treated with methotrexate.  A later ectopic pregnancy, or an ectopic in someone with contraindications to methotrexate, would be treated with surgery (removal of the fallopian tube or of the pregnancy from the fallopian tube).” 

According to Dr. Hack, there are three major misconceptions: 

Myth 1: Ectopic pregnancies can be saved.
This is false. Ectopic pregnancies cannot be saved.

Myth 2: Ectopic pregnancies can be transplanted into the uterus.
This is false. Ectopic pregnancies cannot be transplanted into the uterus. 

Myth 3: Treatment with methotrexate will affect future fertility.
This is false. Methotrexate, the most common drug used to treat ectopic pregnancy, does not affect future fertility. According to the American College of Obstetricians and Gynecologists, methotrexate stops cells from growing, which ends the pregnancy. The pregnancy then is absorbed by the body over 4 to 6 weeks. This does not require the removal of the fallopian tube.

“Confusion from non-medical professionals could promote the belief that treatment of ectopic pregnancies constitutes [their definition of] abortion, preventing us from administering critical, time-sensitive, lifesaving care.  Or state laws can add a level of bureaucracy, preventing or delaying treatment. This has already occurred in some cases, in which physicians have needed to contact hospital ethics boards before providing treatment,” says Dr. Hack.  

While states with abortion bans have exceptions if a person’s life is endangered, interpretations of the laws, as Dr. Hack points to, are murky. This means pregnant people across the United States are in the hands of healthcare providers who aren’t clear on what type of medical care they can provide without being criminally charged. Take for instance the University of Michigan doctor mentioned in this Washington Post article, who sent a woman with a life-threatening ectopic pregnancy home “worried that the presence of a fetal heartbeat meant treating her might run afoul of new restrictions on abortion.”

“In cases of ectopic rupture, patients are actively bleeding and can become unstable,” says Dr. Hack. “In these situations, we do not have time to wait before providing lifesaving care. Our patients' lives depend on our quick, decisive management.” 

Says Dr. Hack: “Fortunately, I practice in a state that recognizes that abortion access is healthcare access. The reversal has not yet affected my ability to provide appropriate care. However, I fear for my colleagues who do not. The inability to do our jobs properly can have multiple casualties.”