Ectopic pregnancy guide

In our ectopic pregnancy guide we look at what is ectopic pregnancy, what are some of the signs of ectopic pregnancy, what are the risk factors, and how it can be treated. 

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 and develops into a baby. In an ectopic pregnancy, the egg implants outside of the womb. 

What is an ectopic pregnancy? 

In simple terms, the word ectopic means “out of place”. An ectopic pregnancy happens when a fertilised egg gets stuck outside your womb (uterus), most often in one of your fallopian tubes. The fertilised egg can’t develop outside the womb and you may need immediate treatment to prevent any complications. Unfortunately, treatment cannot save the pregnancy. 

Rarely, ectopic pregnancies can occur in other areas, including:

  • 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

Sometimes, an ectopic pregnancy may end by itself with a miscarriage. If the pregnancy continues, the egg will continue to grow and split open (rupture) the fallopian tube. This can cause life-threatening internal bleeding and surgery may be needed.  

Signs of an ectopic pregnancy

Early on, it can be difficult to recognise an ectopic pregnancy, and you may only discover that you have the condition during a scan. However, there are some early signs of an ectopic pregnancy to be aware of which include:
  • Pain in your abdomen, usually on one side. This pain is usually sharp and severe, and will not go away.
  • 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 is not diagnosed early, and the fallopian tube stretches to the point where it bursts, you may have the following symptoms:
  • Pain in the tip of your shoulder. This is a sign that the ectopic pregnancy has caused internal bleeding. It’s thought that this bleeding irritates the nerves and organs in your chest, creating pain in the shoulder blade. The pain may be worse if you lie down.
  • Nausea and vomiting.
  • Diarrhoea and blood in the stool (poo).
  • Feeling light-headed, dizzy or fainting.
If you could be pregnant and have any of these signs of sn ectopic pregnancy, seek urgent medical attention. 

Diagnosing an ectopic pregnancy

Your doctor will ask about your symptoms and whether you might be pregnant, as well as doing a physical examination. They may also ask you do a pregnancy test with a sample of your urine. If an ectopic pregnancy is suspected, your doctor will refer you to a specialist for more tests, which can include a blood test, ultrasound, or a procedure called a laparoscopy. 

The blood test will measure the levels of the pregnancy hormone called human chorionic gonadotrophin (HCG). This will not only confirm whether you’re pregnant, but also show if your HCG levels are lower than normal or slowly rising, as this can be a sign of an ectopic pregnancy. 

Sometimes, an ultrasound can show the location of the an ectopic pregnancy. If an ultrasound scan shows your womb is empty but your blood test shows you are pregnant, it's very likely you have an ectopic pregnancy.  

If your doctor is still unsure, you may need to have a procedure called a laparoscopy (also known as keyhole surgery). Your surgeon will use a narrow, tube-like, telescopic camera (called a laparoscope) to look inside your fallopian tubes. They will insert the laparoscope into your tummy through a small cut. A laparoscopy is done under a general anaesthetic so you’ll be asleep during the procedure.

Woman getting an ultrasound

Treatment for an ectopic pregnancy

An ectopic pregnancy must be treated to stop it from growing. The type of treatment will depend on how severe your symptoms are, how advanced your pregnancy is and whether your fallopian tube has ruptured. There are three options for treatment:

  • Medicine
  • Surgery
  • Wait and see (expectant management)

Medicine

If you find out you have an ectopic pregnancy early on, 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 follow-up appointments with your doctor, and blood tests to confirm the pregnancy has ended. Methotrexate is not always successful and some women need repeated treatment or surgery to completely end an ectopic pregnancy. 

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. 

Ectopic pregnancy surgery

Surgery is a common treatment option for an ectopic pregnancy which may be needed when:

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

Ectopic pregnancy surgery can be done via laparoscopy (keyhole surgery). The surgeon will remove the pregnancy and repair the fallopian tube through the small keyhole cut. In some cases, a part or all of the fallopian tube may need to be removed if it is too damaged.  

If the pregnancy is advanced or if there has been severe internal bleeding, your surgeon will usually do this operation through one large cut in your abdomen. You may also need a blood transfusion to replace the lost blood. 

Wait and see (expectant management)

If it seems likely that your ectopic pregnancy will end naturally, the doctor may suggest expectant management, or ‘wait and see’. If this is the case, you will have very little pain, there will be no definite ectopic pregnancy on the ultrasound examination, and your pregnancy hormone levels will be falling. Follow-up tests will be arranged until the pregnancy has completely ended.

Causes of an ectopic pregnancy

About one or two in every 100 pregnancies are ectopic. Often no reason is found, but certain factors can increase the risk. These risks include existing damage to your fallopian tubes. 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 factors that can also increase the chance of having an ectopic pregnancy include: 

  • having a previous ectopic pregnancy
  • being treated for infertility
  • getting pregnant when you are on the progesterone-only birth control pill or 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
 
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