NHS Forth Valley – Ectopic Pregnancy

An ectopic pregnancy occurs when a fertilised egg implants outside the cavity of the womb. The most common site is the fallopian tube, which connects the ovary to the womb.

Why is Ectopic Pregnancy a Problem?

Ectopic pregnancy is a life-threatening condition. As the pregnancy grows, it damages surrounding tissues, causing pain and bleeding. If not recognised and treated, it can rupture blood vessels, which can be fatal. It is not possible to move the pregnancy to the correct position in the womb.

What Causes Ectopic Pregnancy?

Normally, the fertilised egg travels down the tube from the ovary to the womb over 4 – 5 days, implanting about 6 – 7 days after fertilisation. Anything that damages the tube can delay the egg’s passage, allowing it to implant in the tube. In most cases, the cause is never discovered.

What Are the Possible Outcomes?

In most cases, the ectopic pregnancy dies quickly and is absorbed before a period is missed or after minor symptoms. It may not be diagnosed and is thought to be a miscarriage. No treatment is needed in this situation.
If the ectopic does not die, the tube’s thin wall stretches, causing pain in the lower abdomen and possibly vaginal bleeding.
As the pregnancy grows, the tube may rupture, causing severe abdominal bleeding, pain, and shock.

Who Is at Risk?

Past history of pelvic inflammation from infection (e.g. chlamydia), endometriosis, or appendicitis.
Pregnancy while using a coil (IUCD) or after sterilisation.
Previous abdominal surgery.
Any woman of child-bearing age with lower abdominal pain may be suspected of having a tubal pregnancy until proved otherwise.

What Are the Symptoms?

Most cases present between the 4th and 10th week of pregnancy in one of three ways:

Painful and unusual periods. The woman may not know she is pregnant and may have a coil fitted or be sterilised.
Pain or bleeding in early pregnancy. Internal bleeding may cause fainting, shoulder-tip pain, or pain when moving the bowels.
Faintness, dizziness, paleness, and a fast pulse.

How Is Ectopic Pregnancy Managed?

If ectopic pregnancy is suspected, attend hospital for an ultrasound and pregnancy test. If the scan shows an empty uterus but the pregnancy test is positive, an ectopic pregnancy is likely, although miscarriage is possible. It is not always possible to see an ectopic pregnancy on scan.

If you are well and not in severe pain, you may be investigated with serial hormone testing over several days.
Depending on symptoms, you may require immediate surgery:
- Laparoscopy/Laparotomy with removal of tube (Salpingectomy)
- Laparoscopy/Laparotomy with removal of ectopic, conserving tube (Salpingostomy)
In some cases, treatment with Methotrexate (a drug) may be appropriate.

The fertility rate and repeat ectopic rate are similar with all three treatments.

What About the Next Pregnancy?

If a tube ruptured or was removed, ovulation continues but chances of conceiving are reduced.
After treatment, 80% of women who want a baby will become pregnant.
The overall chance of repeat ectopic is 10 – 15%.
If one tube is damaged, there is an increased chance the second tube may be too.
If the coil is removed, there is no increased risk of future ectopic pregnancy.

Questions to Ask Your Doctor

Were there any abnormalities found during surgery?
What is the condition of my reproductive organs, especially my Fallopian tubes?
Are there cysts, endometrial implants, adhesions, evidence of chronic infection, or other problems affecting pregnancy?

What Should I Do in My Next Pregnancy?

Consult your doctor immediately if you suspect you are pregnant again.
If a period is late, menstrual bleeding is different, or there is abnormal abdominal pain, ask to be examined and remind your doctor of your previous ectopic pregnancy.

When May We Resume Sexual Intercourse?

Your doctor will likely wish to see you around 6 weeks after surgery.
It is best to wait until after this check-up.
If you do not want to become pregnant, ask about suitable contraception.
If treated with Methotrexate, wait at least 3 months before trying to conceive again.
Most doctors suggest waiting around two months to allow your body to recover.
You may need time to grieve for the lost pregnancy. Resume intercourse when you and your partner feel physically and emotionally ready.

Coping with Ectopic Pregnancy: Feelings and Emotions

Ectopic pregnancy can be painful and traumatic. You may have had major surgery and may be coping with the loss of an anticipated pregnancy. Feelings can vary greatly, including relief, sadness, anger, or a sense of loss. It is also normal not to experience these feelings, especially if you had more time to accept the diagnosis before treatment.