Ectopic Pregnancy

An ectopic pregnancy is a complication in which the embryo has started to develop outside of the womb. In a normal pregnancy, the egg is fertilised in the fallopian tubes and then travels to the womb where it embeds itself in the thick womb lining and develops there. There are a few different types of ectopic pregnancy but the most common is a tubal pregnancy, where the embryo embeds itself in the fallopian tubes. Ectopic pregnancies are not uncommon and statistics show that it occurs in about one in every 80 pregnancies. Tubal ectopic pregnancies account for around 95% of ectopic pregnancies. In rare cases the embryo can become embedded in the ovary or even the abdomen.

Symptoms of an ectopic pregnancy

An ectopic pregnancy of any sort cannot be saved and in rare cases can even be fatal for the mother. As awful as it is to consider, it really is vital that it is diagnosed and the pregnancy is terminated as soon as possible. Unfortunately, many women will experience very few if any symptoms in the early stages. Symptoms may include a mild to severe pain on one side and/or vaginal bleeding. The only problem with this is that many women mistake it for a period and do not realise that they are pregnant. Bleeding as a result of an ectopic pregnancy will, however, be slightly different to a period and will start and stop. A more unusual, but not uncommon, symptom is shoulder pain. This pain will be worse when you lie down and is caused by the phrenic nerve which is located in the diaphragm, the muscle that separates your chest from your tummy. This is serious and could indicate internal bleeding. You may also experience pain when going to the toilet and/or have diarrhoea and vomiting.

What will happen if I don't get it treated?

In some cases you will have a natural miscarriage but if the embryo continues to develop and grow it will eventually become too large for your fallopian tube and it will rupture. This will cause severe and dangerous internal bleeding and you will require urgent surgery to repair the damage. In very rare cases this can be fatal but usually the tube can be repaired or removed and you will make a full recovery.

Diagnosis

Diagnosis is confirmed by a blood test, vaginal ultrasound or laparoscopy. Pregnancies are usually confirmed due to the increase of the hormone human chorionic gonadotropin (hGC) in blood or urine. In an ectopic pregnancy, this hormone will be present but at a lower level. A vaginal ultrasound is a small probe which can be inserted into the vagina to take images of your womb. This will show the location of your pregnancy. If these are inconclusive then a laparoscopy may be performed in a hospital. This is a type of keyhole surgery where a small camera is inserted directly into your body via a small hole around the naval area. This allows the surgeon to directly examine your womb and fallopian tubes. This is done under general anaesthetic and you may possibly be asked to sign a consent form for emergency surgery to be performed should anything urgent or untoward be found.

Causes of ectopic pregnancies

An ectopic pregnancy occurs when the fertilised egg fails to make its journey into your womb. In a normal pregnancy, tiny hairs or microtubules in the fallopian tubes called cilia gently push the fertilised egg along the tube until it reaches its destination, the womb. Many factors can prevent this from happening. If the fallopian tube is damaged or blocked in any way, the egg may fail to complete its journey and will become trapped. Damage or blockages may be caused by previous ectopic pregnancy meaning that if you have had one before, there is an increased likelihood that it will happen again.

Women who suffer from endometriosis are also at an increased risk. Endometriosis is a condition which causes small pieces of womb lining to be found outside the womb. This can affect the fallopian tubes which increases the risk of an ectopic pregnancy.

An infection in the fallopian tubes or ovaries can also be a factor. If you suffer from pelvic inflammatory disease (PID) then you will also be at an increased risk.

Fertility treatment, specifically that which stimulates ovulation can also cause ectopic pregnancies. In very rare cases contraception methods, namely the pill and the intrauterine device (IUD), can also result in an ectopic pregnancy occurring.

Treatment

Unfortunately, an ectopic pregnancy cannot be saved and the pregnancy will need to be terminated for your own safety. This is a terrible time for all concerned but the focus at this time has to be on the physical health and well being of the woman. If it is diagnosed before it goes so far as to rupture the fallopian tube you will be offered either surgery or medication. There are pros and cons for each option and much will depend on personal choice or the recommendation of the specialist involved.

The medication is given in injection form and has some rather unpleasant side effects including stomach upsets and conjunctivitis. You will also need to be monitored closely for a while after it is administered and will need to undergo a number of blood tests. You will be advised to ensure that you use an efficient form of contraception for at least three months after the medication as it will stay in your system for a while and could cause problems for your next baby if you were to fall pregnant too soon.

Surgery is the more common option and is done by keyhole surgery. This method ensures that the embryo and placental tissue is completely and safely removed. The surgeon will also be able to see if any damage has occurred to the fallopian tube and take the necessary action there and then.

Another option is the 'wait and see' method. Doctors may opt for this if they believe that a 'natural' miscarriage is imminent. You will, however, be closely monitored.

Prevention

There is very little you can do to actively prevent an ectopic pregnancy. You can, however, protect yourself from PID which can cause damage to your reproductive organs, which in turn is a key cause of the condition. PID is usually caused by a sexually transmitted disease such as Chlamydia. Make sure you use a condom when you start a relationship with a new partner and if you are at risk have regular sexual health check-ups.

Coming to terms with it

An ectopic pregnancy is an extremely traumatic experience for all concerned. You will likely feel a deep sense of loss and sadness and this is to be expected. Some women experience feelings of anger and even misplaced guilt. It is not surprising that many women suffer clinical depression after going through this experience. Speak to your GP and ask for some counselling if you are struggling to come to terms with a lost ectopic pregnancy.