Ectopic pregnancy

Abdominal pain

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 know as a tubular 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 the fallopian tubes as it simply hasn’t travelled far enough. 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.

Ectopic pregnancies are usually found 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.

Can an ectopic pregnancy be saved?

An ectopic pregnancy sadly can’t be saved, and you will need to have treatment to remove the egg if it doesn’t dissolve of its own accord.

How common is ectopic pregnancy?

About one in every 90 pregnancies in the UK are ectopic pregnancies.

What are the symptoms of an ectopic pregnancy?

Firstly, it’s worth knowing that ectopic pregnancies can be symptomless so it’s possible you may not find out until you have a scan.

However, there are usually some symptoms. These can come on gradually or all of a sudden. They include:

  • Bleeding – the blood may be different to your period blood or usual pregnancy bleeding). It may be lighter, or brighter, or darker red than usual, or more watery. It is often described as looking like prune juice. There may be clots of blood, but there also may not be.
  • 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 you doctor.
  • Normal signs of pregnancy, including a missed period, tender breasts, extreme tiredness and an increase in cervical mucus

If your ectopic pregnancy is not detected early, the growing embryo may rupture your fallopian tube. usually, this will cause internal bleeding. Signs of symptoms of this internal bleeding include:

  • Feeling dizzy, light-headed or faint
  • Pain when you urinate or pass a stool
  • Diarrhea
  • 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.

What causes ectopic pregnancy?

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 using 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

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’s 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, so 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
  • Feeling dizzy and fainting
  • Being sick
  • Looking very pale

Treatment for ectopic pregnancy

There are several ways to treat an ectopic pregnancy, dependent on how advanced it is and where it has implanted, but sadly none of the treatments will be able to save the baby.

Expectant management

This just means that the situation will be monitored. If the embryo dissolves by itself then no more treatment may be needed.

Medication

You might be given an injection of a drug called methotrexate, which will stop the pregnancy developing.

Surgery

Sometimes it is necessary to physically remove the embryo. This is usually done under general anaesthetic via laparoscopy to remove the egg, often along with the affected fallopian tube.

Does ectopic pregnancy show on pregnancy test?

An ectopic pregnancy test will usually give 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 or ectopic pregnancy – it may just be too early to detect the pregnancy hormone.

If you think you may be having an ectopic pregnancy, see your doctor. They will usually perform blood tests and a scan to confirm whether or not your pregnancy is ectopic.

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 fetus 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.

Can you have your period with an ectopic pregnancy?

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 after an ectopic?

Stay calm. Don't be pessimistic. 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