An ectopic pregnancy is a medical emergency in which a fertilized egg implants and grows outside the main cavity of the uterus. The most common site (in over 95% of cases) is in a fallopian tube. As the pregnancy grows, it can cause the tube to rupture, leading to severe internal bleeding, which is life-threatening.
A pregnancy cannot survive outside the uterus and must be treated to protect the health and future fertility of the woman.
Common Symptoms
Early on, an ectopic pregnancy may feel like a normal pregnancy with a missed period and breast tenderness. Warning signs usually appear between weeks 4 and 12 of pregnancy.
Early Warning Signs
- Pelvic or Abdominal Pain: Often sharp, stabbing, or cramping. It may be on one side.
- Vaginal Bleeding: Different from a period, often lighter, darker, or more watery (“prune juice” appearance).
- Shoulder Tip Pain: A strange pain where your shoulder ends and your arm begins. This is a serious sign of internal bleeding irritating nerves.
- Pain with Bowel Movements or Urination.
Signs of a Rupture (Medical Emergency – you must go to A&E immediately)
- Sudden, Severe, Sharp Abdominal/Pelvic Pain.
- Feeling Faint, Dizzy, or Lightheaded.
- Pale, Clammy Skin, Rapid Heartbeat.
- Collapse or Fainting.
Causes & Risk Factors
An ectopic pregnancy happens when the fertilized egg’s journey to the uterus is blocked or slowed.
Risk Factors Include
- Previous Ectopic Pregnancy.
- Pelvic Inflammatory Disease (PID) or Chlamydia/Gonorrhoea Infection (which can scar the tubes).
- Previous Pelvic or Tubal Surgery (including sterilisation reversal).
- Endometriosis.
- Conceiving with an Intrauterine Device (IUD) in place.
- Smoking.
- Fertility Treatments (IVF).
However, about half of women with an ectopic pregnancy have no known risk factors.
Diagnosis
If an ectopic pregnancy is suspected, you will have immediate tests
- Pregnancy Test (hCG Blood Test): Measures the pregnancy hormone. In an ectopic, hCG levels often rise more slowly than in a normal pregnancy.
- Transvaginal Ultrasound Scan: To locate the pregnancy. If no pregnancy is seen inside the uterus by the time the hCG reaches a certain level, an ectopic is strongly suspected.
- Pelvic Examination: To check for tenderness or a mass.
Treatment Options
Treatment is urgent and depends on your symptoms, the size of the pregnancy, and your hCG level.
Expectant Management (Watchful Waiting)
- Very early, stable ectopics with low and falling hCG levels.
- Close monitoring with blood tests and scans until hCG drops to zero. Only used in select cases.
Medication (Methotrexate)
- Stable ectopics with no rupture, low hCG, and small size.
- An injection that stops the pregnancy cells from growing, allowing the body to reabsorb them.
- Requires careful follow-up with blood tests for weeks until hCG is zero. Avoid pregnancy, alcohol, and certain vitamins for several months.
Surgery
- Laparoscopic (Keyhole) Salpingectomy: Removal of the affected fallopian tube. This is the most common and recommended surgery, especially if the tube is stretched or ruptured, to prevent a repeat ectopic in the same tube.
- Laparoscopic Salpingostomy: An attempt to remove the pregnancy while preserving the tube. This carries a higher risk of some tissue remaining, requiring further monitoring or treatment.
- Emergency Laparotomy (Open Surgery): Required for severe rupture and life-threatening bleeding to stop the bleeding quickly.
Aftercare & Long-Term Considerations
Physical Recovery
- Physical healing from surgery or medication takes a few weeks. Avoid heavy lifting and strenuous exercise as advised.
- You will have follow-up blood tests to ensure hCG levels return to zero.
Emotional Recovery
- This is a significant loss. Feelings of grief, sadness, and anger are normal. Allow yourself time to heal emotionally.
- Seek support from your partner, family, friends, or a professional counsellor.
Future Fertility
- Your future chance of a healthy pregnancy in your uterus is good. If you have one healthy tube, conception is still possible.
- Your risk of having another ectopic pregnancy is higher (about 10%).
- You should see your gynaecologist early in any future pregnancy for an early scan (around 6-7 weeks) to confirm the pregnancy is in the uterus.
Frequently Asked Questions (FAQs)
Q: Could the pregnancy have been saved or moved to the uterus?
A: No. This is not possible with current medical science. The focus of treatment is to safeguard your health and future fertility.
Q: Will I be able to get pregnant again?
A: Yes, most women can. Your fertility depends on the health of your other tube and any other factors. A single ectopic pregnancy does not mean you are infertile.
Q: How long should I wait before trying to conceive again?
A: After methotrexate, you must wait at least 3 months. After surgery, it’s usually advised to wait until after your next normal period (for dating purposes) and when you feel emotionally ready.
Q: Did I do something to cause this?
A: No. Nothing you did or didn’t do caused the ectopic pregnancy. It is a chance occurrence, often with no clear cause.
Q: Will I go through the menopause earlier because of this?
A: No. Removing one fallopian tube does not affect your ovarian reserve or hormone levels. You will still ovulate from both ovaries.
eGynaecologist Advice
- You must seek immediate emergency medical care (A&E/ED) if you have a positive pregnancy test and experience sudden, severe abdominal pain, shoulder tip pain, dizziness, or fainting. This can be a life-threatening situation.
- You should contact your Early Pregnancy Unit or your gynaecologist immediately if you are pregnant and experience any unusual one-sided pain or abnormal bleeding for an urgent assessment.
- You must attend all follow-up appointments and blood tests after treatment for an ectopic pregnancy to ensure it has been completely resolved and seek early pregnancy scan from your gynaecologist in all your future pregnancies.
