An ectopic pregnancy occurs when a fertilised egg implants itself outside of the uterus, usually in a fallopian tube.
Some people refer to ectopic pregnancy as a tubal pregnancy, for this reason.
Ectopic (meaning ‘out of place’) pregnancies are rare, and only affect around 1% of pregnancies.
However, other non-tubal ectopic pregnancies may occur, including cervical pregnancies, ovarian (inside the ovary – rare) and others.
Fertilised eggs have also been known to implant themselves in a uterine scar from a previous c-section.
Here are five things you need to know about ectopic pregnancy:
Causes of ectopic pregnancy
For approximately a third of all cases, doctors are unable to identify the cause of an ectopic pregnancy.
However, there are certain risk factors that can increase your chances.
You are at risk for an ectopic pregnancy if you:
- Are 35 years of age or over
- Are a smoker
- Previously suffered from a pelvic inflammatory disease
- Have had a previous ectopic pregnancy
- Previously had pelvic or abdominal surgery
- Conceived with the help of IVF
- Had a contraceptive IUD (coil) when you conceived
- Have a malformed fallopian tube.
Ectopic pregnancy symptoms
Signs and symptoms of ectopic pregnancy most commonly appear from week five onwards.
Two of the most common symptoms are one-sided abdominal pain (which may be severe and persistent) and vaginal bleeding.
Some women also report some of the following symptoms:
- Shoulder tip pain – felt at the tip of the shoulder, usually most noticeable when lying down
- Painful urination
- Painful passing of stools
- Diarrhoea and vomiting.
Not all women experience symptoms. In fact, some women don’t discover the pregnancy is ectopic until the ultrasound scan.
When to seek help
It’s important to diagnose an ectopic pregnancy as early as possible, to help avoid further complications.
You should contact your healthcare provider if you:
- Experience unusual vaginal bleeding
- Have persistent abdominal pain.
You should contact your healthcare provider as a matter of urgency if you:
- Experience sudden, sharp abdominal pain
- Feel dizzy or lightheaded
- Look unusually pale
- Suffer from sickness or diarrhoea
- Have an increased heart rate.
In an increasingly rare number of cases, the fallopian tube can rupture, causing internal bleeding.
If this occurs, you will need immediate medical help.
Thanks to a better understanding of the condition, and better diagnostics, the number of women experiencing rupture has been greatly reduced.
Ectopic pregnancy treatment
It’s not possible to save an ectopic pregnancy.
Sadly, medical knowledge does not yet exist of how to relocate the embryo to the uterus.
However, there are a number of treatment options available.
The one most suitable for you will depend upon your unique situation.
Treatment options include:
- Active monitoring – some cases of ectopic pregnancy resolve themselves. The pregnancy may be absorbed into your body tissue, leaving you free from the need for further treatment. This will usually be offered as a first treatment option if you are experiencing no or mild symptoms.
- Medication – medication is usually seen as a second choice. It’s most commonly offered when an ectopic pregnancy has been diagnosed early. Once the medication has been administered, you will be closely monitored to ensure the pregnancy resolves itself. Your doctor will then advise you to use contraception for six months. This is because the medication can increase the risk of developmental problems in babies conceived within six months of use.
- Ectopic pregnancy surgery – this is the most common treatment for ectopic pregnancy. The type of surgery depends upon your unique situation. However, laparoscopy (keyhole surgery) is the favoured choice. The surgeon can insert a small camera through a keyhole incision, to investigate the fallopian tubes. In some cases, the pregnancy may be removed, and the fallopian tube repaired. However, it’s also possible for the fallopian tube to be removed.
Methotrexate for ectopic pregnancy
Surgery used to be the only option for ectopic pregnancy.
Methotrexate is a drug which has been used over the last decade.
What it does is ‘dissolve’ the ectopic pregnancy with a single injection, given in the leg or buttock.
After taking methotrexate, only 1 in 15 women will need surgery.
Unlike surgery, methotrexate will not damage a woman’s fallopian tubes, which can impact future fertility.
As always, do your research and read drug information sheets.
The most common side effect is mild abdominal pain after treatment. This should not be severe.
Occasional side effects (for up to 15% of women) include:
What to do after an ectopic pregnancy
Pregnancy loss is devastating, no matter how or when the loss occurred.
You may wish to seek counselling to help you deal with your emotions.
Your healthcare provider should be able to refer you to a counsellor.
You may also find a support group that helps you to cope with the loss.
Ask your healthcare provider if there are any support groups in your local area.
Or you could look for an online group to join.
Be honest with your partner about how you are feeling, and open up to trusted friends and family.
Nobody is expecting you to be okay, so be sure to make the most of the support of your loved ones.
You might be wondering about trying for another baby.
Speak to your healthcare provider to find out when it’s safe for you to start trying.
This will depend on your unique case, so it’s always best to get advice.