An ectopic pregnancy is a pregnancy that implants outside of the uterus. It occurs in approximately 1% of conceptions. It typically grows in the fallopian tube, but rarely an ectopic pregnancy can grow in the ovary or cervix.
A pregnancy has trophoblastic tissue, the purpose of which is to invade deep into the wall of the uterus and set up a system of nutrient and oxygen delivery from the mother to the embryo. Trophoblastic tissue is aggressive, because the muscle of the uterus is thick. Now imagine these aggressive, invasive cells when faced with the wrong tissue. Thinner tissue. These mini Ms. Pacman-like trophoblasts chew up the relatively flimsy fallopian tube tissue, damage blood vessels, and catastrophic bleeding ensues. The pregnancy can literally blow a hole in the side of the fallopian tube, the result is typically catastrophic bleeding.
This is how women die from ectopic pregnancies, they bleed to death. Although thankfully this is very uncommon as we have ultrasounds that identifies these pregnancies very early on, surgery or medication to treat them, and blood transfusions just in case.
The recommended treatment for an ectopic pregnancy is surgical removal or systemic methotrexate (a cancer drug that kills the rapidly dividing trophoblasts, which are in many ways like cancer cells). According to the latest Cochrane review (Interventions for tubal ectopic pregnancy, 2009) there is insufficient data to support expectant management, i.e. watch and wait is not standard of care.
An ectopic pregnancy is not destined to be a baby. It can never, ever grow to viability. It will, however, grow to injure the pregnant woman. So you’d think treatment shouldn’t be controversial…unless of course you want care at some Catholic hospitals.
Yes, some Catholic ethicists argue that the catholic “Directives” preclude physicians at Catholic hospitals from managing ectopic pregnancies in a way that involves direct action on the embryo. So a woman can have her whole tube removed (an unnecessary procedure that could reduce her future fertility), but she can not have the pregnancy plucked out (as is done with the standard therapy, a salpingostomy, where a small incision is made in the tube and the pregnancy removed) and she most certainly could not have the methotrexate.
How common is this practice? Well, it is pretty sad that someone had to study it. According to a study from 2011 by Foster e. al., (Womens Health Issues, 2011) some Catholic hospitals refuse to offer methotrexate (three in this study of 16 hospitals). The lack of methotrexate resulted in changes in therapy, transferring patients to other facilities, and even administering it surreptitiously. All of these expose women to unnecessary risks, expense and are, quite frankly, wrong.
It amazes me that with ectopic pregnancy, such a clear-cut case of life of the mother with therapies well supported in the literature, that any physician or hospital could have any other moral or ethical agenda than delivering the right medical care.
Putting religious beliefs ahead of urgent/emergent medical care in never right and I shudder to think how the management of ectopic pregnancies would change should a national personhood amendment pass.