What is an ectopic pregnancy?
Ectopic pregnancy is a common, potentially life–threatening, condition affecting one in 100 pregnancies. An ectopic pregnancy occurs when the fertilised egg implants outside the cavity of the womb, usually in the fallopian tube. As the pregnancy grows, the fallopian tube stretches causing pain. If not treated quickly enough, the tube can burst, causing internal bleeding, which can lead to collapse and even death.
What causes an ectopic pregnancy?
Normally a fertilised egg travels from the ovary down the fallopian tube and implants into the wall of the womb six to seven days after fertilisation. In an ectopic pregnancy the egg does not travel to the uterus or womb but instead implants somewhere outside the womb, usually in one of the narrow fallopian tubes where it cannot develop properly. In most cases the exact cause of an ectopic pregnancy is unknown but it is often a result of some sort of damage to the fallopian tube. The tube may have become blocked or narrowed by previous surgery or infection.
One of the most important causes of infection (pelvic sepsis, PID (pelvic inflammatory disease) and salpingitis) is chlamydia which may have no symptoms.
What are the symptoms of an ectopic pregnancy?
These are often difficult to distinguish, meaning that an ectopic pregnancy is not always straightforward to diagnose, but you should look out for:
- A missed or late period.
- A positive urine pregnancy test.
- Abdominal pain – this can be persistent and severe. It may be on one side only, but not necessarily on the side where the ectopic is.
- Shoulder tip pain.
- Abnormal bleeding – this may be lighter or heavier than a normal period, and more prolonged. This bleeding is often dark in colour & watery (similar to prune juice).
- Diarrhoea or sometimes pain when opening the bowels.
- Fainting, or feeling dizzy or light headed.
Who is at risk of an ectopic pregnancy?
Any sexually active woman of child-bearing age is at risk, but the presence of the following factors increases the possibility:
- Aged between 25 and 34 years old
- History of pelvic inflammatory disease, such as Chlamydia
- Previous abdominal surgery, such as removal of the appendix
- Intra Uterine Contraceptive Device (IUCD) (coil)
- Taking the progesterone-only contraceptive pill (mini pill)
- IVF treatment
- Previous ectopic pregnancy
How is an ectopic pregnancy diagnosed?
Usually by an internal or transvaginal ultrasound scan, which provides a better view of the womb, ovaries and fallopian tubes. It involves inserting an ultrasound probe into the entrance of the vagina. However it is not always possible to see an ectopic pregnancy on scan. If you are clinically well, you may have to have two blood tests (serial βhCG) over a 48-hour period to help with the diagnosis.
How is an ectopic pregnancy treated?
Usually treated in one of three ways. The first way is to perform an operation, usually by keyhole surgery to remove the damaged fallopian tube and the ectopic pregnancy at the same time. This is called a laparoscopy. The second method of treatment involves an injection called Methotrexate. This is a drug that stops the ectopic from growing, but you will need to be carefully monitored by your hospital. In rare cases the ectopic is small enough to be managed without any drugs or any surgery. You may need several ultrasound scans to watch the pregnancy carefully as it comes to an end by itself.
What happens after an ectopic pregnancy?
If you had a laparoscopy, you can try for another baby as soon as you like, but if you were treated with Methotrexate you will be advised to avoid pregnancy for 3-6 months. When you do get pregnant again it is a good idea for your GP to arrange an ultrasound in early pregnancy. This should be at about 7 weeks after your last period. The scan is done as a precaution to confirm that your pregnancy is in the right place this time and not another ectopic. There is no risk to your baby if you had an ectopic in the past.