Ectopic Pregnancy

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.

The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won’t develop into a baby and your health may be at risk if the pregnancy continues.

Unfortunately, it is not possible to save the pregnancy. It usually has to be removed using medicine or an operation.

In the UK, around 1 in every 80-90 pregnancies is ectopic. This is around 12,000 pregnancies a year.

 

ek-ectopic-bagel

An ectopic pregnancy does not always cause symptoms and may only be detected during a routine pregnancy scan.

If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy.

Symptoms can include a combination of the following:

  • A missed period and other signs of pregnancy.
  • Tummy pain low down on one side.
  • Vaginal bleeding or a brown watery discharge.
  • Pain in the tip of your shoulder.
  • Discomfort when passing urine or opening bowels.

However, these symptoms are not necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a stomach bug.

Contact your GP or call NHS 111 if you experience a combination of any of the above symptoms and you might be pregnant, even if you have not had a positive pregnancy test.

An ectopic pregnancy can be serious, so it is important to obtain advice right away.

Your GP will ask about your symptoms and you will usually need to do a pregnancy test to determine if you could have an ectopic pregnancy.

You may be referred to specialist early pregnancy clinic for further assessment, where an ultrasound scan and blood test may be carried out to assist in the diagnosis.

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you experience a combination of the following:

  • A sharp, sudden and intense pain in your lower tummy.
  • Feeling very dizzy or fainting.
  • Feeling sick.
  • Looking very pale.

These symptoms could mean that your fallopian tube has split open (ruptured). This is very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible.

A rupture can be life- threatening, but fortunately they are uncommon and treatable, if dealt with quickly. Deaths from ruptures are extremely rare in the UK.

There are three main treatments for an ectopic pregnancy:

  • Expectant management – you are carefully monitored and one of the treatments below is used if the fertilised egg does not dissolve by itself.
  • Medication – an injection of a powerful medicine called methotrexate is used to stop the pregnancy growing.
  • Surgery – keyhole surgery (Laparoscopy)performed under a general anaesthetic is used to remove the fertilised egg, usually along with the affected fallopian tube.

You will be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have.

Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to become pregnant. Talk to your doctor about this.

Losing a pregnancy can be devastating and many women feel the same sense of grief as if they has lost a family member or partner.

It is not uncommon for these feelings to last for several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.

If you or your partner are struggling to come to terms with your loss, you may benefit from

professional support or counselling. Speak to your GP about this.

Support groups for people who have been affected by loss of a pregnancy can also help.

These include:

  • The Ectopic Pregnancy Trust.
  • The Ectopic Pregnancy Foundation.
  • The Miscarriage Association.
  • Cruse Bereavement Care.

You may want to try for another baby when you and your partner feel physically and emotionally ready.

You will probably be advised to wait until you have had at least two periods after treatment before trying again, to allow yourself to recover. If you were treated with Methotrexate, it is usually recommended that you wait at least three months, because the medicine could harm your baby if you become pregnant during this time.

Most women who have had an ectopic pregnancy will be able to become pregnant again, even if they have had had a fallopian tube removed. Overall, 65% of women achieve a successful pregnancy within 18 months of an ectopic pregnancy. Occasionally, it may be necessary to use fertility treatment such as IVF.

The chances of having another ectopic pregnancy are higher if you have had one before, but the risk is still small (approx 10%).

If you do become pregnant again, it is a good idea to let your GP know as soon as possible, so an early scan can be performed to check everything is well.

In many cases, it is not clear why a woman has an ectopic pregnancy. Sometimes it occurs when there is a problem with the fallopian tubes, such as them being narrow or blocked.

The following are all associated with an increased risk of an ectopic pregnancy:

  • Pelvic inflammatory disease(PID) –inflammation of the female reproductive system, usually caused by a sexually transmitted infection (STI).
  • Previous surgery on the fallopian tubes – such as an unsuccessful female sterilisation procedure.
  • Fertility treatment, such as IVF – taking medication to stimulate ovulation 9the release of an egg)can increase the risk of an ectopic pregnancy.
  • Becoming pregnant with an intrauterine device (IUD) or intrauterine system (IUS) for contraception -it is rare to become pregnant while using these, but if you do, you are more likely to have an ectopic pregnancy.
  • Increasing age – the risk is highest for pregnant women who are aged 35-40 years.