'Ectopic' means 'out of place' and in an ectopic pregnancy the fertilised egg implants somewhere outside the uterus, most often in one of the fallopian tubes. In rare cases the pregnancy tries to establish itself in an ovary, the cervix or completely outside the reproductive system in the abdomen. Wherever it implants outside the womb, however, an ectopic pregnancy is unsustainable, and the baby cannot be brought to term. In the UK about one in one hundred pregnancies are ectopic, and the rate is far higher in some other countries.
Many women may not even realise that they have suffered an ectopic pregnancy, as often the pregnancy ends itself before the mother is affected. However, if you have had a positive pregnancy test, or if an ectopic pregnancy is diagnosed quite late, the experience can be a very traumatic one; all the more so if you require surgery and experience damage to your fallopian tubes as well as losing your pregnancy.
For the first four or five days after conception the fertilised egg is usually gently propelled down the fallopian tube by contracting motion of the fallopian tube itself and the wafting motion of the millions of tiny hairs, cilia, which line it. After four or five days the majority of eggs will have reached the uterus where they burrow into the uterine wall, about a week after conception. In an ectopic pregnancy, the egg is somewhere other than the uterus, usually the fallopian tubes, when it is time to implant and so tries to implant in the lining of the fallopian tube, causing damage to the maternal tissues.
Often an ectopic pregnancy will spontaneously abort, perhaps even before a woman realises that she is pregnant. If so the woman may think that she has had an unusual period or an early miscarriage, and an ectopic pregnancy may not be diagnosed.
However, when the pregnancy does not spontaneously abort, as the embryo grows it causes damage to the maternal tissues, stretching the fallopian tube and most likely causing pain and bleeding. If the ectopic pregnancy continues to grow undiagnosed it will eventually rupture the fallopian tube, causing internal bleeding, pain and, usually, maternal collapse.
What are the symptoms?
In some cases there are no symptoms at all before the pregnancy aborts itself, and the woman may never even realise that she was pregnant. In other cases the first sign that something is wrong may be maternal collapse, which require emergency transfer to hospital. However, there are some common symptoms indicating a pregnancy may be ectopic:
- Abdominal pain, particularly on one side - is a common symptom of an ectopic pregnancy. The pain may be severe and persistent, but it may not be on the side affected by an ectopic pregnancy. It's important that any abdominal pain in women of childbearing age is checked out by the doctor, whether the woman believes she is pregnant or not
- Unusual vaginal bleeding - an ectopic pregnancy may result in bleeding that is darker or lighter than your usual period, and often of a more watery consistency, sometimes described as similar to prune juice
- Bowel / urinary pain - a woman may experience discomfrot or pain when passing urine or stools
- Dizziness / fainting - an ectopic pregnancy may be accompanied by a falling blood pressure, light-headedness and feeling faint. In some cases the first sign that anything is wrong may be the woman collapsing
- A feeling that something is very wrong - A woman with an ectopic pregnancy may have nausea and vomiting, diarrhoea, be very pale or have clammy skin. She may feel that something is very wrong with her without knowing what it is
- Shoulder-tip pain - displaced pain in the tip of the shoulder may be caused by internal bleeding irritating the diaphragm
- Low HcG levels - in ectopic pregnancies the pregnancy hormone HcG often increases at a significantly lower rate than that of normal pregnancies. This may alert your doctor to a possible ectopic pregnancy
If you suspect you may have an ectopic pregnancy it is vital that you go straight to your doctor to be checked out: Early diagnosis can help prevent damage to your fallopian tubes, can lessen the likelihood that you will lose a fallopian tube and in some cases may save your life.
How is ectopic pregnancy diagnosed?
If an ectopic pregnancy is suspected but the woman is not aware of a pregnancy the first test to be done is a pregnancy test. If a pregnancy is already established, doctors may look at the woman's hCG levels (the levels of the pregnancy hormone) to see whether it is increasing as would be expected in a normal pregnancy: low levels of hCG may indicate an ectopic pregnancy.
If the woman is pregnant then an ultrasound (usually through a vaginal probe) is done to look for a pregnancy in the uterus first, and if that's not found then outside the uterus.
If a pregnancy cannot be found with ultrasound, doctors may use a laparoscope, a very thin tube with a camera inserted through a small cut in the abdomen, to look around the inside of the abdomen for an ectopic pregnancy and possibly to remove it when found.
How is ectopic pregnancy treated?
If a woman has an ectopic pregnancy it is impossible to carry the pregnancy to birth, the baby cannot grow to term outside the womb. If the embryo continues to grow the damage that it causes to the mother's internal organs could be fatal. Thankfully fatalities from ectopic pregnancies are relatively rare, and most ectopic pregnancies can be successfully treated.
- Expectant management - This is an increasingly common way of handling a diagnosed ectopic pregnancy when the mother has mild or no symptoms. You are kept under observation (at home or hospital, depending on the circumstances) to see whether the pregnancy aborts itself with no medical intervention, or whether the pregnancy continues to grow, in which case intervention will be necessary.
- Treatment with drugs - In some cases, where an ectopic pregnancy is diagnosed early enough, it may be possible to treat the ectopic pregnancy with a drug called methotextrate which acts to end the pregnancy.
- Surgery - It is often necessary to remove the embryo through surgery to protect the mother. Surgery is 'keyhole', using a very small incision in the abdomen. Your abdomen is pumped with carbon dioxide before-hand to help separate the organs and give surgeons a clear view inside. If the surgery is carried out before rupture of the fallopian tube the tube should survive intact, but when the fallopian tube is damaged then it may need to be removed in part or entirely.
- Emergency surgery - If the signs are that your fallopian tube has already ruptured and you are experiencing internal bleeding then you will require emergency surgery. In this case it is quite likely that a fallopian tube may need removing.
The first place to seek support is from your medical team, who should be able to give you plenty of help and advice. The Ectopic Pregnancy Trust offers a wealth of information and support, including a telephone help line (0207 733 2653, 10 - 4 on work days) as well as a busy support forum. There are also, of course, many waiting and sympathetic ears here on the ThinkBaby forum.
What causes ectopic pregnancies and what could increase the risk of developing one?
Damage to the fallopian tube is one known cause of ectopic pregnancy, if there is a blockage in the tube, or damage to the cilia, the egg may not be propelled along to the uterus as it should be. Often, however, a cause for an ectopic pregnancy cannot be established and around 50% of women who experience ectopic pregnancy aren't exposed to any of the following factors which are known to increase the risk rate:
- Surgery of the fallopian tubes - any surgery involving the fallopian tubes, including surgery to treat a previous ectopic pregnancy.
- Abnormality of the fallopian tube- A natural abnormality of the fallopian tubes, such as a bent tube
- Pelvic Inflammatory disease - PID is an infection and inflammation of the upper female genital tract that can lead to scarring of the reproductive areas. It is most often, but not exclusively, caused by sexually transmitted diseases.
- Endometreosis - A condition where the womb lining grows outside of the womb, endometriosis may cause damage to the fallopian tubes.
- Some contraceptive methods - Use of a progesterone-releasing intrauterine contraceptive device (IUD), such as the coil, and use of the mini-pill have both been associated with increased risk of ectopic pregnancy when a woman falls pregnant while using those forms of contraception
- IVF - In-vitro fertilisation increases the risk of an ectopic pregnancy developing
- Aging - Some studies have shown that the risk for women over the age of 44 rises from about 1% to 8% (see NHS direct
I have had an ectopic pregnancy, am I at risk of it happening again?
The UK's Ectopic Pregnancy Trust estimates the chance of a subsequent pregnancy also being ectopic at 7-10%. While a previous ectopic pregnancy does raise your risk for your next pregnancy, your chances of having a normal pregnancy are still good. Even if you have lost one fallopian tube you still have a 50% chance of carrying a pregnancy to term, and more severe damage can still leave you the option of fertility treatment.
It is very important that you tell your doctor as soon as you think you may be pregnant again after an ectopic pregnancy so that you can benefit from early screening this time around.