It affects one in 90 pregnancies and can be potentially life-threatening if untreated.
By Annie Hayes
Ectopic pregnancy affects one in 90 pregnancies, equivalent to approximately 11,000 each year. It occurs when the fertilised egg attaches somewhere outside of the womb, often in one of the fallopian tubes.
Unfortunately, this means the egg won’t develop into a baby – it’s not possible to move it into the womb – and your health may be at risk if the pregnancy continues. Left untreated, an ectopic pregnancy can potentially be life-threatening. It can be a real shock to be given the diagnosis of an ectopic pregnancy so it is perfectly normal if you feel very upset.
We spoke to Ashfaq Khan, consultant obstetrician and gynaecologist at Harley Street Gynaecology, about the causes, symptoms, treatment options and future outlook for ectopic pregnancy:
What is an ectopic pregnancy?
Ectopic pregnancy is when the fertilised egg (ovum) attaches itself outside of the cavity of the womb (uterus) – ectopic means ‘misplaced’. Unfortunately, a fertilised egg can’t properly grow anywhere other than the womb. If the egg tries to grow elsewhere, it can cause health complications.
Each month, before a woman’s period, one of her ovaries produces an egg. As it travels through the fallopian tube towards the womb – pushed along by tiny finger-like cilia – it may become fertilised by sperm. If so, it implants itself into the lining of the womb (the endometrium) and grows into a baby. If the egg is not fertilised, it’s discharged along with the lining as part of the menstrual flow.
When an ectopic pregnancy occurs, the egg has typically gotten stuck during its journey through the fallopian tube.
When an ectopic pregnancy occurs, the egg has typically gotten stuck during its journey through the fallopian tube. It continues to grow there, causing damage to the tube and potentially resulting in a rupture. When this happens, it can cause internal bleeding and pain, and requires immediate medical attention.
While the fallopian tubes are a common site of an ectopic pregnancy, there are many other sites where the egg can be located. In rare cases, it may attach itself in one of the ovaries, the cervix, or another organ within the pelvis. Regardless of the location, an ectopic pregnancy requires treatment with medication, or possibly surgery.
Ectopic pregnancy symptoms
At first, an ectopic pregnancy develops like a uterine pregnancy, which means common pregnancy symptoms such as nausea, a missed period and tender breasts will be present. However, in an ectopic pregnancy, the woman may also experience:
- Vaginal bleeding– from spotting and discharge to heavy bleeding
- Severe pain on one side of the abdomen
- Sharp pain in the shoulder or neck
- Pelvis or abdomen pain that starts mild and grows stronger
- A feeling of heaviness in the pelvis
- Feeling faint or dizzy
- Diarrhoea or pain when passing poop
Symptoms typically develop around the sixth week of pregnancy, although they may occur any time between four and 10 weeks. Some women have no symptoms at all, and only become aware of the ectopic pregnancy once heavy internal bleeding occurs.
If you are pregnant and experience throbbing on one side of your lower abdomen or sudden pain, contact your doctor or call NHS 111 immediately. An ectopic pregnancy can be life-threatening if it ruptures and causes internal bleeding.
What causes ectopic pregnancy?
The cause of ectopic pregnancy isn’t always clear. However, there are certain risk factors that may increase the likelihood of experiencing an ectopic pregnancy. These include:
• Damaged fallopian tubes
Inflammation and scarring of the fallopian tubes from a prior medical condition, infection, or surgery is associated with a greater risk of ectopic pregnancy. Any trauma to the fallopian tubes can cause the cilia to beat in an abnormal fashion, which may lead the fertilised egg to implant in the wrong place. This can be caused by:
- Sexually transmitted infections, such as chlamydiaor gonorrhoea
- Pelvic Inflammatory Disease
• Previous ectopic pregnancy
If you have previously had an ectopic pregnancy, there’s an increased chance another will occur. The risk increases further if you have experienced two or more.
• Certain contraceptive methods
• In vitro fertilisation (IVF)
When using the test-tube method to overcome infertility, one or more eggs are inserted into the woman’s uterus. Despite being placed within the womb, the fertilised egg may still attach itself to the wrong area outside the cavity of the uterus.
How is ectopic pregnancy confirmed?
If your symptoms indicate you may have an ectopic pregnancy, you will usually be seen immediately. ‘As this condition can be life threatening, any early pregnancy vaginal bleeding and abdominal pain should be investigated without delay,’ says Khan.
The doctor will use a blood test that measures levels of the pregnancy hormone human chorionic gonadotrophin (hCG), and take a transvaginal ultrasound scan to differentiate between a possible miscarriage, a continuing pregnancy inside the womb and an ectopic pregnancy. ‘Sometimes the scan and blood test may need to be repeated,’ says Khan.
If your symptoms indicate you may have an ectopic pregnancy, you will usually be seen immediately.
Any further investigation depends on the symptoms, scan findings and levels of hCG in the blood. If your symptoms are severe – significant pain, heavy bleeding and fainting – there may not be enough time to complete these steps, because the fallopian tube could rupture. In this instance, your doctor will perform emergency surgery.
Ectopic pregnancy treatment
Treatment options for an ectopic pregnancy vary depending on the location of the ectopic pregnancy and its development. The egg will need to be removed to protect the health and long-term fertility of the mother, and this can occur in several ways:
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If the ectopic pregnancy has been identified very early on and you have mild symptoms or none at all, your doctor may suggest you are monitored very closely to see if the pregnancy dissolves of its own accord in a similar way to a miscarriage. You will be required to have regular scans and blood tests and may require treatment later down the line.
Your doctor may inject you with a medicine called methotrexate (Maxtrex), which halts the growth of cells in the ectopic pregnancy. As a result, the pregnancy shrinks and disappears, accompanied by symptoms such as nausea, vomiting and stomach cramps.
This method avoids surgery, which can cause lasting fallopian tube damage. However, you will be under close observation for several weeks, with repeated blood tests and scans, to ensure the medication has worked. Very rarely, you may still require surgery.
A gynaecologist may perform a laparoscopy (keyhole surgery) to remove the egg, which involves making small incisions in the abdomen. The fallopian tube in which the ectopic pregnancy occurred is often – but not always – removed at the same time, depending on the health of the other tube.
In some instances, open surgery becomes necessary. This will involve the ectopic pregnancy being removed through a larger incision above the pubic hair line. This generally only becomes an option if technical problems occur during the laparoscopy or internal bleeding in the abdominal cavity is difficult to control.
What’s the outlook for future pregnancies?
The long-term outlook for future pregnancies after an ectopic pregnancy depends whether the fallopian tube is damaged. If one or both of the fallopian tubes are still intact, the egg can be fertilised as usual. If not, you may need to consider fertility treatments such as IVF.
Your doctor will likely advise you to wait until you’ve had at least two periods before trying for a baby following an ectopic pregnancy. If you were treated with methotrexate, it’s usually recommended that you wait at least three. Most women will be able to get pregnant again, even if they’ve had a fallopian tube removed.
Your doctor will likely advise you to wait until you’ve had at least two periods before trying for a baby following an ectopic pregnancy.
It’s not possible to prevent an ectopic pregnancy. If you’ve experienced one in the past and are currently trying for a baby, let your GP know. Keep a close eye on any signs of pelvic infection – vaginal discharge, abnormal vaginal bleeding – and be sure to have an early pregnancy scan and blood tests, says Khan.
An ectopic pregnancy can be devastating, and it’s common to experience a lasting sense of grief, so make sure you and your partner give yourself time to come to terms with the loss. You may also benefit from professional support or counselling. If you need advice, speak to your doctor or try one of the resources listed below.