Ectopic pregnancy

Specialty of Obstetrics & gynaecology

What is ectopic pregnancy?

Ectopic pregnancy is a problem with the implantation of a fertilised egg cell. In a normal pregnancy, the fertilised egg attaches itself to the lining of the uterus. Ectopic pregnancy involves the fertilised egg implanting and growing outside the uterus, in places such as:

  • the fallopian tube
  • the ovary
  • the cervix
  • the abdominal cavity

Just over 1% of pregnancies are ectopic. Unfortunately, the fertilised egg cannot survive in an ectopic pregnancy.

Prognosis

The severity of the condition depends on where the egg is growing. If the egg is growing in the fallopian tube and isn’t detected early enough it can lead to fallopian tube rupture and heavy bleeding, which can be life-threatening.

Symptoms of ectopic pregnancy

An ectopic pregnancy can cause:

  • vaginal bleeding
  • pain when going to the toilet
  • pain on one side of your abdomen
  • pain in your shoulder

Not all people with ectopic pregnancy experience symptoms and it might only be diagnosed during a routine pregnancy scan.

However, you should seek emergency help if you get a sudden intense pain in your abdomen, accompanied by dizziness or nausea, as this can be an indication of a ruptured fallopian tube. In this situation you will need emergency surgery to repair or remove the tube and control the bleeding.

How is ectopic pregnancy diagnosed?

After an assessment of your symptoms, the doctor will order some blood tests and a vaginal ultrasound. The blood test can help not only with diagnosis but with treatment, as you may need a blood transfusion.

In some cases, a form of keyhole surgery called a laparoscopy might be recommended if it’s still difficult to make a diagnosis. If an ectopic pregnancy is found, the fertilised egg can be removed during the same procedure.

What causes ectopic pregnancy?

The following can increase your chances of an ectopic pregnancy:

You’re also more likely to experience an ectopic pregnancy if you are between the ages of 35 and 40.

Tubal pregnancy (where the egg attaches itself to the lining of the fallopian tube) is caused by a blockage that stops the egg travelling to the uterus. This may be the result of fallopian tube surgery or damage due to inflammation.

Can ectopic pregnancy be prevented?

You can reduce your risk of ectopic pregnancy by stopping smoking and reducing your chances of sexually transmitted infections.

How is ectopic pregnancy treated?

Treatment for ectopic pregnancy depends on how early it has been detected.

If the diagnosis was made early and you don’t have unstable bleeding, ectopic pregnancy can be treated with an injection of methotrexate, which should dissolve any existing cells. You’ll be monitored with follow-up blood tests and you may need to continue taking contraceptive medication for the next few months.

If medication doesn’t work, or if the pregnancy is more advanced, surgery is generally recommended. A laparoscopy is performed under general anaesthetic and involves inserting small surgical tools to remove the ectopic pregnancy. If your fallopian tube is damaged and the other one is healthy, the surgeon might also remove the damaged fallopian tube.

After treatment you might have a follow-up appointment with a fertility specialist to discuss your chances of getting pregnant and get advice on when to start trying again.

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