Ectopic pregnancy - symptoms and treatment
Ectopic pregnancies account for one in 80-90 pregnancies in the UK. You’re fairly unlikely to suffer one, but it’s worth knowing about the symptoms and what to do if you suspect your pregnancy is ectopic. While it’s not possible to save the baby, acting quickly could make an enormous difference to your health and future fertility, too.
What is an ectopic pregnancy?
An ectopic pregnancy, also known as a tubal pregnancy or fallopian tube pregnancy, occurs when an egg is successfully fertilised but implants outside of the womb. In most cases (around 98%), the fertilised egg implants in one of the fallopian tubes after failing to reach the womb. It can also, less commonly, lodge itself in an old caesarean scar, the abdomen, ovary or cervix. Once implanted outside of the womb, the embryo grows, often causing pain or bleeding. It will eventually rupture if not treated.
Ectopic pregnancy symptoms
Firstly, it’s worth knowing that you might not experience any symptoms of an ectopic pregnancy at all. For that reason, it's possible you may not find out until you have a scan. However, there are usually some symptoms that can come on gradually or all of a sudden. Signs include:
- Bleeding – the blood may be different to your period blood or usual pregnancy bleeding. It may be lighter, brighter, or a darker red than usual, or more watery. It is often described as looking like prune juice. There may be clots of blood, but not always.
- Mild to severe pain in the abdomen or pelvis – like period pain, but it may be low down and on one side or the other, rather than in the middle. The abdominal pain/pelvic pain may come on gradually or suddenly. If you experience this kind of pain and think there is a chance you might be pregnant, contact your GP.
- Normal signs of pregnancy – these include a missed period, tender breasts, extreme tiredness and an increase in cervical mucus.
I spotted from the day my period was due and tested when I was a week late (still spotting) and it was positive. Had a couple of little twinges.
Apparently, about 50% of ectopics resolve and you never know about them. The rest, if left undetected, get to a point that can be life-threatening – so it's important that you're checked if you suspect you have one.
If the pregnancy is not detected early, the growing embryo may rupture your fallopian tube, causing internal bleeding. Signs of internal bleeding include:
- Feeling dizzy, light-headed or faint
- Pain when you urinate or pass a stool
- Shock, or collapse, due to severe internal bleeding
- Pain at the point where your shoulder ends and your arm begins. Internal bleeding can irritate other internal organs, such as your diaphragm. The pain may be worse when you lie down, and it may be unaffected by taking painkillers.
How common is it?
About one in every 90 pregnancies in the UK are ectopic, which equates to about 12,000 pregnancies per year – according to the NHS.
Can ectopic pregnancies be saved?
Sadly, they can’t be saved and there is no way of moving the egg to the womb. You will need to have treatment to remove the egg if it doesn't dissolve of its own accord.
Ectopic pregnancy causes
The most common cause is a blocked or partially blocked fallopian tube, meaning that the egg can't travel out and into the womb. As a result, it ends up implanting in the tube itself.
One in three women have none of the known risk factors of ectopic pregnancy. However, these are some of the factors that are known to increase your chances of having one:
- Having pelvic inflammatory disease
- Having had abdominal surgery, including a caesarean section, appendix removal or failed sterilisation
- The pregnancy having been conceived via IVF (for this reason you usually have a scan early on if you’ve had IVF)
- Using the IUD or mini pill as contraception when you conceived
- Having gonorrhoea or chlamydia
- Being an older mum
- A congenital abnormality of the fallopian tubes
- Having had one previously
The impact of contraception
Contraceptives reduce the risk simply by virtue of reducing the risk of pregnancy itself. It's when that contraception fails that there's a slightly increased risk of a pregnancy being ectopic, compared with non-users.
There's also thought to be a slightly stronger link between certain forms of contraception and ectopic pregnancy. In a study undertaken in Shanghai, there was found to be a slight increase in risk for women who had previously used an intra-uterine device, and this risk increased with duration of use. Similarly, the mini pill may slightly increase the risk if it should fail, as movement of the egg through the fallopian tube is impeded.
What should I do if I think my pregnancy is ectopic?I had two ectopic pregnancies in a six-month period and went on to have a normal pregnancy.
If you have some of the symptoms listed above, it’s worth getting checked out at your GP surgery or early pregnancy assessment unit. Some have walk-in appointments, while at others you'll need a referral for a scan.
It's diagnosed by confirming you're pregnant with a urine test and also doing blood tests, a pelvic exam and a scan to confirm where the egg has implanted.
The treatment you're offered will depend on the symptoms you are experiencing, as well as the results of the tests carried out.
When to call 999
A rupture would mean you need surgery immediately. If you think it might be serious, call an ambulance or get taken straight to A&E.
These are the signs to look out for:
- Sudden and sharp intense pain in the abdomen
- Fainting and dizziness
- Nausea and vomiting
- Pain in the abdomen lasting more than half an hour
Ectopic pregnancy treatment
There are several methods of treatment, depending on how advanced your pregnancy is and where the embryo has implanted. Sadly, none of the treatments will be able to save the baby, but it's very important to contact your GP as soon as possible. The pregnancy will not progress but, if left unmonitored, could be very dangerous to your own health. While fatalities are extremely rare in the UK, it's vital that you're treated accordingly.
This just means that the situation will be monitored closely, but no action will be taken unless complications arise. As long as you have low levels of hCG, they continue to fall, and you're not in too much pain, this is the likely course of action. If the embryo dissolves by itself, it may be that no more treatment is needed. If, however, your hCG levels continue to rise, your doctor will probably advise one of the two treatments below.
You might be given an injection of a drug called methotrexate, which will stop the pregnancy from developing by inhibiting your body's production of folate for a while. The embryo will then dissolve, meaning that you won't need to have surgery, and your fallopian tube will remain intact. You'll be asked to stop taking any folic acid supplements at this time.
Common side effects of the methotrexate drug include cramping, nausea, tiredness, dizziness and bleeding or spotting, which can last a few weeks. The bleeding will usually come on a few days after you've had the injection and, along with any cramping, will be monitored by your doctor.
You'll then have several follow-up appointments at hospital to make sure that your hCG levels are falling, and that they eventually become negative again.
Sometimes it is necessary to physically remove the embryo. This is usually done under general anaesthetic using laparoscopy (keyhole surgery) to remove the egg, often along with the affected fallopian tube. The surgeon will take into account how badly damaged the tube is and balance it against the health of your other tube in order to make a decision about removing it. If your other tube is not healthy, the surgeon may try to remove the egg without removing the tube by making a small incision in it.
Does it show on a pregnancy test?
You will usually get a positive result on a pregnancy test, as the hormone produced still gets into the blood stream. If you do a test and the result is negative, it's very unlikely that it is an ectopic pregnancy. However, there are rare situations when this can happen.
Remember that a negative pregnancy test never rules out a pregnancy, even an ectopic one – it may just be too early to detect the pregnancy hormone.
If you think your pregnancy may be ectopic, see your doctor for medical advice. They'll usually perform blood tests and a scan to find out for sure.
How long can it last?
A fetus in an ectopic pregnancy can sometimes survive for several weeks. However, because tissues outside the uterus cannot provide the necessary blood supply and support, he or she ultimately cannot survive. The structure containing the fetus typically ruptures after about six to 16 weeks, which is much too early for a fetus to be viable.
Will you have a period at the same time?
You may have some of the signs of a normal pregnancy, including a missed period. However, you may experience some spotting or bleeding. If you're experiencing symptoms of a pregnancy which you think could be ectopic, see your doctor.
Trying againI know of five women who had ectopic pregnancies and had tubes removed, and all went on to have healthy children naturally.
If and when you try for another baby after depends on many factors.
First of all, how do you feel about it? Many women want to start trying again as soon as they have the all-clear. For others, the idea of being pregnant again seems overwhelming and (understandably) frightening, and they want to have a bit of a break before thinking about trying to conceive.
When can I try again?
Your GP will usually advise you to wait at least two periods before starting to try to conceive again. If you had methotrexate, you may have to wait three months as it can hang around in your body and can cause problems in a new pregnancy.
Many women feel they want to wait a little longer, though. It’s an entirely personal decision.
Will an ectopic pregnancy affect my fertility?
If you had to have a fallopian tube removed, obviously that does reduce your chances – but over half of women will go on to have a natural, successful pregnancy within 18 months of a pregnancy which was ectopic. If you're having trouble conceiving again due to the ectopic, you may be offered IVF.
The Ectopic Pregnancy Trust states that “statistically, the chances of having a future successful pregnancy are very good and 65% of women are healthily pregnant within 18 months of an ectopic pregnancy. Some studies suggest this figure rises to around 85% over 2 years.”
Am I more likely to have another one if I’ve had one before?
It does increase your risk factor, but the risk is still relatively small – about one in ten.
What should I do when I find out I’m pregnant again?
Stay calm. Try not to be pessimistic (easier said than done, we know). There’s a 90% chance your next pregnancy will not be ectopic.
As soon as you know you are pregnant, visit your GP and ask for an early scan so they can check early on where the embryo has implanted.
Where can I get help and support?
Losing a pregnancy, whatever the stage, can be devastating. It's normal to experience grief and deep sadness. You may feel this way for a few months, maybe longer, and that's OK. Give yourself time to grieve and process your feelings.
The Ectopic Pregnancy Trust has some good reading on the emotional impact, and provides some resources for help with emotional recovery and looking after your wellbeing.
If you or your partner are having difficulty coming to terms with your loss, you may benefit from professional support. Talk to your GP about the counselling options available to you.
There are also support groups available for people who have experienced loss of a pregnancy.
I've told my closest friends what happened to me. I wanted them to understand why I wasn't my normal self and I wanted to be able to talk about it with them. Through them, I now know of five women who had ectopics and had tubes removed and all went on to have healthy children naturally.
It took me about four months to move out of my black mood over it all, and really I needed every day of it.
I keep thinking I want to be back to normal, but it's taking a while – not quite there yet. I had some acupuncture yesterday and I do feel a lot better after that. I'm sleeping better.