Ectopic pregnancy
What is an ectopic pregnancy?
An ectopic pregnancy occurs when a fertilised egg implants outside the uterus (womb).
In a normal pregnancy, the fertilised egg spends 4 to 5 days travelling down the fallopian tube before moving to the cavity of the uterus where it implants about 6 to 7 days after being fertilised.
Most, but not all, ectopic pregnancies take place in the fallopian tube. Early detection of an ectopic pregnancy can prevent serious medical complications and may save the fallopian tube from permanent damage.
Cause of ectopic pregnancies
There are several conditions that can cause an ectopic pregnancy.
Any damage to the fallopian tube can block or narrow the fallopian tube. There could also be problems with the tube walls, which should normally tighten and carry the fertilised egg into the uterus.
Hormonal imbalance, infection or malfunction of the uterus or tube can all impair the tube’s normal function and result in an ectopic pregnancy.
Who is most at risk?
You are most at risk of having an ectopic pregnancy if you have a previous history of:
- ectopic pregnancy
- salpingitis (pelvic infection)
- damage to your fallopian tube
- infertility
- pelvic surgery including tubal ligation (having your fallopian tubes’ tied or clamped to prevent pregnancy).
Other risk factors include:
In some cases the cause of an ectopic pregnancy may never be known.
Possible outcomes
In many cases of ectopic pregnancy, the fertilised egg dies quickly and is broken down by your system before you miss your period or after you experience some slight pain and bleeding.
In these cases an ectopic pregnancy is rarely diagnosed and it is assumed to be a miscarriage. Nothing needs to be done in these circumstances.
If the fertilised egg continues to grow, the thin wall of your fallopian tube will stretch, causing you pain in your lower abdomen. You may also experience vaginal bleeding. As the egg grows, the tube may rupture, causing you severe abdominal (stomach) pain, internal bleeding and possible collapse.
Signs and symptoms
Women who experience an ectopic pregnancy have all the signs of a normal pregnancy, in the beginning. Most symptoms of an ectopic pregnancy occur between the fourth and tenth week of pregnancy. These include:
- vaginal bleeding
- lower left or right side abdominal (stomach) pain
- feeling light-headed or faint.
If you experience these symptoms you should see your doctor or visit your local hospital immediately.
Managing an ectopic pregnancy
If an ectopic pregnancy is suspected, your doctor will perform an ultrasound scan and a pregnancy test.
If the ultrasound scan shows an empty uterus but the pregnancy test comes back positive, then it is likely you have an ectopic pregnancy.
These signs may also indicate that you are in very early stages of pregnancy or that you have already miscarried.
While an ultrasound using a transvaginal probe provides the best quality scan, it is not always possible to see an ectopic pregnancy.
If you are well and not in severe pain, you may have a blood hormone test each day for up to 2 to 3 days to help diagnose if you have an ectopic pregnancy.
Treatment of ectopic pregnancy
Currently there are 3 different treatments available for an ectopic pregnancy.
Your doctor will discuss the most appropriate one for you, however, your doctor may also find it necessary to proceed from one method to another.
Laparoscopic (keyhole) surgery to remove fertilised egg from fallopian tubes
A telescopic device (the laparoscope) is inserted through a small cut below your navel (belly button). To help identify your organs, carbon dioxide gas is blown into your stomach through a needle.
A couple of small incisions are also made in your lower abdomen to manipulate and if necessary remove the ectopic pregnancy tissue.
The surgery may involve removing your fallopian tube (salpingectomy) or opening your fallopian tube (salpingostomy) to remove the ectopic pregnancy tissue.
Laparotomy to remove the ectopic pregnancy
If the pregnancy is advanced or there has been significant associated haemorrhaging (bleeding) then your doctor may perform a laparotomy, a type of surgery involving a much larger incision.
Intramuscular injection of the drug methotrexate
A medication called methotrexate is used to dissolve the pregnancy tissue. It is given by injection in the leg or bottom and is suitable for women without pain or those with minimal pain.
This type of treatment was introduced to avoid surgery but needs careful follow-up.
The follow-up requires blood tests after the first week and then once or twice a week until tests show that you are no longer pregnant. The schedule of blood tests will be explained to you by your doctor. The treatment has a 90 per cent success rate. If it is not successful your doctor may have to reconsider medical treatment or surgery.
Recovery after treatment
After laparoscopic surgery or a methotrexate injection most women recover and are ready to leave hospital within 24 hours.
After a laparotomy it is more common to stay in hospital for 2 to 3 days.
If you had a salpingostomy or methotrexate injection you will need to have regular tests at hospital to ensure all the pregnancy cells are gone. This usually involves another blood hormone test.
A discharge summary will be sent to your doctor describing the treatment you have received and any further care you may need.
See your doctor if:
- you have a high temperature or feel feverish
- your surgical cuts become red, swollen or contain pus
- your vaginal discharge has a strong, unpleasant odour
- you have heavy, bright red vaginal blood loss or blood clots
- you feel unwell or worried about an unusual symptom.
Future pregnancies
If you have had an ectopic pregnancy then you have a slightly higher risk of having another ectopic pregnancy in the future.
The risk of ectopic pregnancy in the general population is 1 in 50 to 80 women. The risk of a repeat ectopic pregnancy is 1 in 10.
See your doctor immediately if you:
- think you might be pregnant
- have a late period
- have abnormal abdominal pain
- have menstrual bleeding that is different to normal.
You should ask to be examined, reminding your doctor of the previous ectopic pregnancy.
Contraception
If you have had an ectopic pregnancy, some contraception methods may no longer be suitable. It is best to discuss your medical history and options with your doctor or at a family planning clinic.
Your emotions
An ectopic pregnancy can be a devastating experience.
You may be recovering from major surgery while at the same time trying to cope with the loss of your pregnancy and possibly the loss of part of your fertility. You may be worried about whether you can have a baby in the future.
You may also be dealing with the shock of finding out you were pregnant just as your pregnancy is ending.
It’s normal for your emotions to be up and down for weeks and even months after your loss. You may feel utterly relieved to be pain free and profoundly grateful to be alive, while feeling sad about your loss.
If you didn’t have much time to mentally prepare for your treatment, you may feel that you lost control of the decision-making process.
These emotional reactions that you and your partner may experience can test your own relationship and your relationships with others, such as family and friend. You both may find it hard to understand or meet each other’s emotional needs.
Many people, especially men, may find it difficult to express their feelings. They may feel powerless to help. During this time it’s important to talk to each other about how you both feel and share your grief.
After experiencing an ectopic pregnancy your feelings can vary. Some women want to get pregnant again immediately while others are terrified at the thought and cannot cope with another anxious pregnancy.
Allow yourself time to recover physically and emotionally before trying to get pregnant again. It is recommended that you wait for at least 3 months for your body to recover. You are the best judge of the time needed for your emotional healing.
Getting support
Support services at King Edward Memorial Hospital
A range of support services are available at King Edward Memorial Hospital if you have experience a pregnancy loss, including:
- social work
- pastoral care
- counselling and psychiatric services.
Talk to your doctor or midwife, or read more about the support services for pregnancy loss available at King Edward Memorial Hospital.
You may wish to read such resources as:
- Small sparks of life Lysanne Sizoo, Gopher Publishers, 2001
- Hidden Loss: Miscarriage & Ectopic Pregnancy. Contributing editors: Valerie Hey, Catherine Itzen, Lesley Saunders, and Mary Anne Speakman. The Women's Press Handbook Series 1989.
Where to get help
Remember
- Ectopic pregnancy is a pregnancy that develops outside of the uterus and usually in the fallopian tubes.
- Symptoms can include vaginal bleeding, stomach pain and cramps.
- Women at high risk should have their pregnancy closely monitored especially during the early stages.
- An ectopic pregnancy is a life-threatening condition.
Acknowledgements
Women and Newborn Health Service
This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.