Ectopic pregnancy

Abdominal pain from ectopic pregnancy

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 might 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%) it 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 and eventually will rupture if not treated.

This type of pregnancy is usually discovered somewhere between week four and week 14 of pregnancy, but most often at week six, because that’s when pregnancy symptoms usually start to kick in.

ectopic pregnancy diagram

Ectopic pregnancy symptoms

Firstly, it’s worth knowing that you might not experience any symptoms at all, so 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 of ectopic pregnancy 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 pain may come on gradually or suddenly. If you experience this kind of pain and think there is a chance you might be pregnant, see your doctor.
  • 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 is important that you are 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
  • Diarrhoea
  • Shock, or collapse, due to severe internal bleeding
  • Pain at the point where your shoulder ends and your arm begins, if internal bleeding irritates 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 and so ends up implanting in the tube itself.

One in three women who have an ectopic pregnancy have none of the known risk factors, but 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
  • Smoking
  • Being an older mum
  • A congenital abnormality of the fallopian tubes
  • Having had an ectopic pregnancy previously

Contraception and ectopic pregnancy

Contraceptives reduce the risk of ectopic pregnancy 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 is 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 will need a referral for a scan.

An ectopic pregnancy is diagnosed by confirming you are 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 are offered will depend on the symptoms you are experiencing and the results of the tests carried out.

When to call 999

An ectopic pregnancy can rupture, which 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 is very important to see your doctor 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 are treated accordingly.

Expectant management

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 are not in too much pain, this is the likely course of action. If the embryo dissolves by itself then no more treatment may be needed. If, however, your hCG levels continue to rise, your doctor will probably advise one of the two treatments below.

Medication

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 will 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 will then have several follow-up appointments at hospital to make sure that your hCG levels are falling and eventually become negative again.

Surgery

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 ectopic pregnancy 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 is 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. They will usually perform blood tests and a scan to find out for sure.

How long can an ectopic pregnancy last?

A fetus in an ectopic pregnancy sometimes survives for several weeks. However, because tissues outside the uterus cannot provide the necessary blood supply and support, the 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?

With an ectopic pregnancy, 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 are experiencing symptoms of an ectopic pregnancy, see your doctor.

Trying again after an ectopic pregnancy

I 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 an ectopic pregnancy depends on many factors.

First of all, how do you feel about it? Many women want to crack straight on as soon as they have the all-clear and feel that only a successful pregnancy will make them feel better about what happened. 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 again.

When can I try again after an ectopic pregnancy?

Your doctor 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 65% of women will go on to have a natural, successful pregnancy within 18 months of an ectopic pregnancy. If you’re having trouble conceiving again due to the ectopic, you may be offered IVF.

Am I more likely to have an ectopic pregnancy 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 after an ectopic pregnancy?

Losing a pregnancy, whatever the stage, can be devastating. It is normal to experience grief and deep sadness after an ecoptic pregnancy. You may feel this way for a few months, maybe longer. That's OK. Give yourself time to grieve and process your feelings.

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. These include:

The Ectopic Pregnancy Trust
The Ectopic Pregnancy Foundation
The Miscarriage Association
Cruse Bereavement Care

I have 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.