An ectopic pregnancy is a pregnancy that implants outside the uterus (womb). Ectopic means ‘outside’ or ‘in the wrong place’.
About one or 2 in 100 pregnancies in Australia is an ectopic pregnancy. Most of the time ectopic pregnancies occur in one of the fallopian tubes, which carry eggs from the ovary to the uterus. An ectopic pregnancy in one of the fallopian tubes is sometimes called a tubal pregnancy. Rarely, ectopic pregnancies can occur in other places, including the ovaries or inside the abdomen.
What are the symptoms of an ectopic pregnancy?
In the early stages an ectopic pregnancy seems just like a normal pregnancy. A period will usually be missed and other common signs of pregnancy (such as sore breasts and morning sickness) may be present.
The pregnancy hormone beta HCG (which is what gives a positive pregnancy test) will be produced as for normal pregnancies.
Symptoms that indicate a possible ectopic pregnancy typically occur at about 6 to 7 weeks of pregnancy, but can occur anywhere from 4 to 12 weeks. Many women still do not know that they are pregnant at this stage. Sometimes an ectopic pregnancy is detected during a routine pregnancy ultrasound scan before any symptoms have developed.
As the embryo grows, the fallopian tube cannot enlarge with it and the problem reveals itself. The fallopian tube will stretch and cause pain.
Symptoms may include:
- vaginal bleeding (which may be mistaken for a delayed period) or discharge that may be watery and brown;
- pelvic or abdominal pain, sometimes felt more on one side;
- nausea and vomiting;
- feeling light-headed or dizzy;
- fainting; and
- shoulder tip pain.
If the fallopian tube ruptures, it can result in severe pain and often internal bleeding. This can be life threatening. For this reason vaginal bleeding and lower abdominal pain in early pregnancy must never be ignored.
Pain that is felt at the tip of your shoulder can be a sign of irritation of the diaphragm. In the case of ectopic pregnancy, internal bleeding can collect under the diaphragm and cause this symptom.
When to see your doctor
Contact your doctor immediately or dial 000 for an ambulance if you have any of the following symptoms and it’s possible you could be pregnant (even if you haven’t had a positive pregnancy test).
- Vaginal bleeding and cramping pain shortly after a late period.
- Sudden, severe pain in the lower abdomen.
- Bad pains that do not feel like period pains.
- Dark bleeding which starts after the pain.
- Shoulder tip pain.
- Faintness, nausea, dizziness and vomiting.
What causes ectopic pregnancy?
When a woman becomes pregnant, what usually happens is that sperm travel through the female reproductive system to the fallopian tubes and fertilise an egg that has been released from one of your ovaries. The fertilised egg then continues to travel down the fallopian tubes to the uterus, where it should implant.
In the case of an ectopic pregnancy, the fertilised egg implants in the fallopian tube itself and starts to grow there. Fallopian tubes cannot expand and stretch to accommodate a growing pregnancy the way the uterus can.
Factors that can increase the risk of an ectopic pregnancy include the following.
- Previous infections in the fallopian tubes (pelvic inflammatory disease).
- Previous surgery to the fallopian tubes, including tubal sterilisation (having your tubes tied as a form of permanent contraception).
- Having fertility treatment such as IVF.
- Previous surgery to the pelvis or abdomen (which can cause scar tissue – adhesions – that can increase the risk of an ectopic pregnancy).
- Becoming pregnant with an intra-uterine contraceptive device (IUCD, or IUD) in place.
- Becoming pregnant while taking the progestogen-only pill (mini pill).
- Having endometriosis.
- Being older than 40 years of age.
- Being a smoker.
- Having previously had an ectopic pregnancy.
Diagnosing an ectopic pregnancy
Your doctor will ask about your symptoms and whether you are (or could be) pregnant. They will also perform a physical examination and ask you to do a urine pregnancy test.
If your doctor is at all suspicious of an ectopic pregnancy they will either admit you to hospital or organise special tests such as:
- a pelvic ultrasound; and
- blood tests measuring the amount of the pregnancy hormone beta HCG in your body.
An ectopic pregnancy may be diagnosed when a pregnancy test is positive but an ultrasound shows that the womb is empty. Sometimes the ultrasound can show the location of the ectopic pregnancy.
Occasionally, a laparoscopic examination is recommended. This involves using a small telescope-like device — a laparoscope — which is inserted through a tiny opening in your abdomen. If an ectopic pregnancy is found it is usually removed by laparoscopic surgery. Sometimes the affected fallopian tube also needs to be removed.
Ectopic pregnancy is a serious condition that needs to be treated. A pregnancy can’t develop normally outside the uterus (womb), and unfortunately treatment cannot save the pregnancy. It is necessary to remove the pregnancy from the fallopian tube to stop it from rupturing, which can cause life-threatening internal bleeding.
The type of treatment recommended will depend on your symptoms, test results and general health.
Surgery is the most common treatment used to remove the ectopic pregnancy. Sometimes all or part of the affected fallopian tube is also removed.
Surgery is often done laparoscopically, using a small telescope-like device called a laparoscope, which is inserted through a tiny opening in your abdomen. This procedure is done under a general anaesthetic.
Sometimes laparoscopic surgery is not possible and an operation with a larger incision is needed.
Expectant management (watch and wait)
Close monitoring may be the only treatment needed for some women. This treatment is only suitable in certain circumstances. Women with no symptoms and with decreasing levels of pregnancy hormones may be suitable.
In some cases, ectopic pregnancy can be treated with a medicine called methotrexate to stop the pregnancy growing. This is usually only suitable when the ectopic pregnancy is detected early and is still very small. Methotrexate is given as an injection. In some cases, the medication doesn’t work and a second injection or surgery is needed to treat the ectopic pregnancy.
With expectant management and treatment with medication, close follow up is essential. Your doctor will want to check that your pregnancy hormone levels are falling (with repeat blood tests) and that there is no pregnancy tissue remaining (with follow-up ultrasound scans).
Ectopic pregnancies end in the loss of a pregnancy, which can be a difficult time for you and your partner. Support is available following ectopic pregnancy. Talk to your doctor about how you are feeling.
Getting pregnant again
Most doctors recommend that women who have had an ectopic pregnancy don’t try to get pregnant again straight away. If you had treatment with methotrexate, you should wait 3 to 4 months before trying for another baby. Waiting 2 months after surgical treatment is usually recommended.
Surgery for an ectopic pregnancy can affect future fertility, especially if there is a problem with your other fallopian tube. However, having only one fallopian tube usually means your chance of pregnancy is only slightly reduced.
Your doctor will be able to discuss whether your fertility is likely to be affected and if fertility treatment is recommended.
Most women who have had an ectopic pregnancy are able to go on to have a normal pregnancy. In future pregnancies, your doctor may recommend having an ultrasound scan at 6-8 weeks of pregnancy to confirm that it is not an ectopic pregnancy.
Your doctor will be able to give you further information and advice on getting pregnant again that is specific for your circumstances.
2. NHS Choices. Ectopic pregnancy (updated 3 Feb 2016). http://www.nhs.uk/Conditions/Ectopic-pregnancy/Pages/Introduction.aspx (accessed May 2016).
3. American College of Obstetricians and Gynecologists (ACOG). Ectopic pregnancy (updated Aug 2011). http://www.acog.org/Patients/FAQs/Ectopic-Pregnancy (accessed May 2016).