Welcome to Laurie’s Big Blog – May 2020

Every month we will identify the 6 most commonly asked questions about ectopic pregnancy and answer them. If you have any further questions which you cannot find answers on the website, please can you contact us.

 

What does ectopic pregnancy mean?

Ectopic is derived from the Greek word Ectopios meaning displaced, away from a place, out of place. With regards to pregnancy, an ectopic pregnancy is one located outside the uterine cavity.

Most ectopic pregnancies are in the Fallopian tube, but rarely in other sites. These include the cervix (neck of the womb) or in the scar of a previous Caesarean section(s). These rare cases can be a challenge both in terms of diagnosis and management.

Is ectopic pregnancy viable?

An ectopic pregnancy is non-viable and there has never been a single case reported in the world literature of an ectopic pregnancy producing a live infant.

Where does ectopic pregnancy cause pain?

The classic presentation on an ectopic pregnancy is a late period, dark brown vaginal discharge and unilateral (one-sided) constant lower pelvic discomfort or pain.
If the ectopic pregnancy is leaked or ruptured then bleeding occurs into the abdominal cavity causing diaphragmatic irritation resulting in shoulder pain when lying flat.

Other presentations of ectopic pregnancy include vague gastro-intestinal symptoms, including abdominal discomfort or pain on defecation. It is important to exclude ectopic pregnancy in such patients with a pregnancy test and other investigations if indicated.

When do you get ectopic pregnancy symptoms?

The symptoms of ectopic pregnancy vary greatly and this is why it can be so difficult to diagnoses, there may be no symptoms at all.
The symptoms usually developed at about six weeks after the last period and can consist of the following:
1) prune juice vaginal discharge or vaginal bleeding
2) one sided constant lower abdominal pain
3) vague gastrointestinal symptoms including pain on deification
4) shoulder tip pain
5) feeling light headed and faint or actually fainting

It is important to remember that symptoms maybe vague and trivial yet the patient have a leaking ectopic which is a life threatening condition.

How is ectopic pregnancy surgery done?

Surgery is undertaken under general anaesthetic. If the ectopic pregnancy is in the Fallopian tube (the most common site) the procedure undertaken is either partial or total removal of the tube (partial or total salpingectomy); this depends on the findings at operation. Rarely, a cut is made over the tube containing the ectopic pregnancy and the pregnancy is removed (linear salpingotomy). This operation is carried out when the other Fallopian tube is damaged.

Surgery for ectopic pregnancy can be either laparoscopically “keyhole“ (the vast majority) or open laparotomy. The decision as to which approach is best is based on the assessment of the patient and findings at operation. Contraindications to laparoscopic surgery include multiple previous operations and pelvic adhesions making it impossible to visualise the pelvic organs. The advantages of keyhole surgery are smaller surgical scars, a shorter hospital stay, and a quicker recovery time. The chance of a subsequent successful pregnancy is the same whether you have open or laparoscopic surgery.

To view laparoscopic surgery please click on the video section on the website but please note these videos contains graphic images of surgery and we feel unsuitable for those under the age of 18.

What causes an ectopic pregnancy?

There are a number of risk factors for ectopic pregnancy. These include:
1) pelvic inflammatory disease (PID) “salpingitis”
2) appendicitis
3) previous ectopic pregnancy
4) fertility treatment
5) previous Caesarea section(s)
6) any previous abdominal or pelvic surgery
7) smoking

It is important to remember that a woman can develop an ectopic pregnancy with none of these risk factors.