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Ectopic pregnancy

In a usual, healthy pregnancy, an egg released by your ovary is fertilised by sperm in one of your fallopian tubes. It then travels to your womb where it implants in the lining. However, about one in every 100 pregnancies are what’s called ectopic. An ectopic pregnancy is when a fertilised egg implants outside your womb (uterus), most often in one of your fallopian tubes. The fertilised egg can’t survive and you may need immediate treatment to prevent any complications.

As well as in one of your fallopian tubes, other places that a fertilised egg can implant are:

  • at the point where your fallopian tube meets your womb
  • in one of your ovaries
  • at the neck of your womb (cervix)
  • in your abdomen (tummy)
  • in a caesarean scar

The pregnancy may end by itself or it could continue to grow and split open (rupture) the fallopian tube. This can cause life-threatening internal bleeding.

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Image showing the different places where ectopic pregnancy can occur

Details

  • Symptoms Symptoms of ectopic pregnancy

    The symptoms of ectopic pregnancy can vary. You may not have any at all and only discover that you have the condition during a scan. However, the most common symptoms to be aware of include the following.

    • Pain in your abdomen, usually on one side. Although this can be mild it may be extremely severe. It may come on over a few days or suddenly without any warning.
    • Unusual bleeding from your vagina. This may be heavier or lighter than your usual periods, and it may be a different colour.

    If the ectopic pregnancy bleeds, you may get the following symptoms.

    • Pain in the tip of your shoulder. This is because if the ectopic pregnancy bleeds into your abdomen, this can in turn affect nerves that run to your shoulder. The pain may be worse if you lie down.
    • Diarrhoea and vomiting.
    • Feeling faint. If your fallopian tube ruptures, you may have serious internal bleeding causing you to suddenly collapse, feel dizzy or faint.

    If you have missed a period or could be pregnant and have any of the symptoms described here, seek urgent medical attention.

  • Diagnosis Diagnosis of ectopic pregnancy

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

    Your GP will ask you to have a pregnancy test. This will involve testing a sample of your urine for a hormone called human chorionic gonadotrophin (hCG). This hormone is made by the cells that form the placenta. If you have the symptoms of an ectopic pregnancy, a negative pregnancy test doesn’t rule out the possibility but does make it highly unlikely.

    If your pregnancy test is positive, or your symptoms strongly suggest you have an ectopic pregnancy, your GP will refer you to a specialist. The specialist will be in a hospital and will give you some further tests. If you have severe symptoms of an ectopic pregnancy, your GP may refer you straight to hospital as an emergency.

    You may have a blood test for hCG and an ultrasound scan at hospital. An ultrasound uses sound waves to produce an image of the inside of your womb. If the scan shows your womb is empty but your blood test shows high levels of hCG, it's very likely you have an ectopic pregnancy. You may need to have another hCG blood test two days later to help your doctor to diagnose your condition.

    If your doctor is still unsure, you may need to have a procedure called a laparoscopy. Your surgeon will use a narrow, tube-like, telescopic camera (called a laparoscope) to look inside your fallopian tubes. He or she will insert the laparoscope into your abdomen through a small cut. You’ll usually have a general anaesthetic so you’ll be asleep during the procedure.

  • Treatment Treatment of ectopic pregnancy

    An ectopic pregnancy may either get smaller and end by itself, or get bigger and eventually split (rupture) your fallopian tube. This is a medical emergency. Your treatment will depend on how severe your symptoms are, how advanced your pregnancy is and whether or not your fallopian tube has ruptured.

    Watchful waiting (expectant management)

    You might not need any treatment for an ectopic pregnancy because sometimes the pregnancy ends by itself. If you don’t have any symptoms or your symptoms are mild, your doctor may offer you the option of not having any treatment. Instead, he or she will monitor you closely and ask you to have blood tests and possibly, further ultrasound scans.

    Medicines

    If you find out you have an ectopic pregnancy early on in the pregnancy, your doctor may give you an injection of a medicine called methotrexate. This will stop the growth of the embryo cells and the pregnancy will gradually be absorbed by your body. You may need to have more than one dose of methotrexate.

    You’ll need to have a number of follow-up appointments with your doctor. You may need to have blood tests and further ultrasound scans to ensure the pregnancy has ended.

    It’s important not to get pregnant again within three months of having a methotrexate injection or within six months if you need two injections. This is because methotrexate is harmful to a developing baby so you will need to wait for its effects to wear off.

    Surgery

    You may need surgery to remove your ectopic pregnancy (and possibly your fallopian tube) if:

    • medicines haven’t worked
    • your pregnancy is quite advanced
    • you have severe pain

    Usually you’ll have keyhole surgery using a laparoscope for ectopic pregnancy. Your surgeon may remove the pregnancy by using a device to suck (aspirate) it out of your fallopian tube. Alternatively, they may remove part or all of your fallopian tube.

    If your fallopian tube ruptures, you may need to have emergency surgery to stop the internal bleeding. Your surgeon will remove your fallopian tube and the pregnancy. You may also need a blood transfusion if the internal bleeding is severe. Your surgeon will usually do this operation through one large cut in your abdomen. Occasionally if you’re having a keyhole surgery, your surgeon may need to convert to an open operation for technical reasons.

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  • Causes Causes of ectopic pregnancy

    An ectopic pregnancy can develop if your fallopian tubes are damaged. This could happen if you have had an infection, such as pelvic inflammatory disease. If your fallopian tubes have been damaged, they may become inflamed, narrowed or scarred. This makes it harder for the fertilised egg to pass down them to your womb.

    Other things that make an ectopic pregnancy more likely include:

    • having a previous ectopic pregnancy
    • being treated for infertility
    • getting pregnant when you have an intrauterine device (coil) fitted
    • smoking
    • being over 35
    • having had a sterilisation operation – if the surgery fails and you get pregnant, it’s possible this may be an ectopic pregnancy

    However, for more than half of women who have an ectopic pregnancy, the cause is unknown.

  • Prevention Prevention of ectopic pregnancy

    It isn’t possible to prevent an ectopic pregnancy but you can reduce your risk. These include quitting smoking and taking measures to protect yourself against sexually transmitted infections (STIs), which can damage your fallopian tubes.

  • Help and support Help and support

    It’s important to recognise that an ectopic pregnancy can affect you emotionally as well as physically. You may feel sadness and a sense of loss after having an ectopic pregnancy. If you can, try to talk to someone about these feelings. Ask your doctor for information about support that’s available to you.

  • FAQs FAQs

    If it’s left to develop, could an ectopic pregnancy turn into a successful one?

    Answer

    No, ectopic pregnancies aren’t able to develop properly so it would never be possible for one to survive.

    Explanation

    It isn’t possible for a pregnancy to survive if it implants outside your womb. Only your womb provides the right environment for a baby to grow and receive all the nutrition it needs.

    If the pregnancy implants in your fallopian tube, there is a risk it will cause your fallopian tube to split open (rupture). This can cause severe bleeding and if left untreated, can be life-threatening.

    Because an ectopic pregnancy can’t survive, the most important thing to consider when deciding on treatment is your health.

    Is it true that using the coil for contraception increases your risk of ectopic pregnancy?

    Answer

    The coil is a contraceptive device and will reduce the chance of you getting pregnant. However, if the coil fails and you do get pregnant, there is a greater risk of an ectopic pregnancy.

    Explanation

    The risk of becoming pregnant when you have had an intrauterine contraceptive device (coil) fitted is lower than if you don’t use any contraception. However, even though it’s very unlikely, if you have had a coil fitted, you may still become pregnant. If this happens, you’re slightly more likely to have an ectopic pregnancy. About one in 20 women who become pregnant with a coil in place have an ectopic pregnancy. The coil is good at stopping pregnancies from implanting in your womb but isn’t as good at preventing conception in your fallopian tubes.

    Will I be able to get pregnant again after an ectopic pregnancy?

    Answer

    Most women can get pregnant again after an ectopic pregnancy although it will depend on the type of treatment you had.

    Explanation

    If you’ve had an ectopic pregnancy, you shouldn’t have any more trouble getting pregnant again than a woman who hasn’t had one. Even if you had your fallopian tube removed to treat the ectopic pregnancy, your chance of conceiving may only be slightly reduced.

    However, you may be more likely to have another ectopic pregnancy. About one in 10 women will have another ectopic pregnancy and this rises to a quarter of women who have two or more ectopic pregnancies. This is because if you have an ectopic pregnancy, one of your fallopian tubes is likely to have been damaged or even removed. However, this will depend on the type of treatment you had. As surgical methods have advanced and treatment with methotrexate is becoming more common, fewer women are having problems with later pregnancies.

    If you get pregnant again, it’s important to see your GP as soon as you find out. You’ll need to have an ultrasound scan six to seven weeks into your pregnancy to check the embryo is developing in your womb. An ultrasound uses sound waves to produce an image of the inside of your body.

    How your baby develops, stages of pregnancy by Bupa UK Click on the image to open our stages of pregnancy infographic.

     

     

     

     

     

     

  • Resources Resources

    Further information

    Sources

    • Tubal ectopic pregnancy. BMJ Clinical Evidence. www.clinicalevidence.bmj.com, published July 2011
    • Ectopic pregnancy. Medscape. www.emedicine.medscape.com, published 2 May 2014
    • Conception and prenatal development. The Merck Manuals. www.merckmanuals.com, published October 2013
    • Ectopic pregnancy and miscarriage. National Institute for Health and Care Excellence (NICE), December 2012. www.nice.org.uk
    • An ectopic pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, reviewed August 2010
    • Ectopic pregnancy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2013
    • HCG test. Lab Tests Online. www.labtestsonline.org.uk, published 19 December 2013
    • Ectopic pregnancy. PatientPlus. www.patient.co.uk/patientplus, reviewed 31 January 2013
    • Laparoscopic management of tubal ectopic pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published June 2010
    • Intrauterine contraceptive device (IUCD). PatientPlus. www.patient.co.uk/patientplus, reviewed 2 April 2014
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