Ectopic pregnancy

In the majority of pregnancies once an egg has been fertilised by a sperm it travels along the fallopian tube into the uterus where it implants in the fertile lining and begins to develop. However, occasionally the fertilised egg will implant outside the womb - this is known as an ectopic pregnancy.

Most ectopic pregnancies (over 95%) implant in a fallopian tube although they do also occur in the ovaries, cervix or abdomen. Unfortunately, embryos are unable to survive anywhere outside the womb as they do not have the space or nourishment to develop and grow. Sadly this means that ectopic pregnancies have to be removed as they pose such a great health risk to the mother.

Why do ectopic pregnancies occur?

There is no way to predict who will conceive an ectopic pregnancy as there is no one condition or reproductive problem that is known to cause implantation outside the womb. However, any condition that causes a blockage of the fallopian tubes or a delay in the movement of a fertilised egg towards the womb may increase the likelihood of a pregnancy being ectopic.

Factors known to increase the likelihood of an ectopic pregnancy include Pelvic Inflammatory Disease (e.g. chlamydia or gonorrhoea), abdominal surgery (including sterilisation reversal), increased age and having 3 or more terminations. Previous ectopic pregnancy and conception by IVF are also known to increase the risk, however individuals who fall in this category do tend to be very closely monitored by their health care professional during the early stages of pregnancy and so are detected early.

Symptoms

Initially the symptoms of an ectopic pregnancy are very similar to those signifying miscarriage. These include pregnancy symptoms such as tender breasts, fatigue and testing positive on a pregnancy test coupled with dizziness, (non-menstrual) vaginal bleeding and abdominal pain on one side.

If an ectopic pregnancy proceeds without treatment then the encasing fallopian tube may rupture and cause severe internal bleeding. Symptoms of this include sudden, severe abdominal pain, shoulder pain (this is caused by blood leaking into the abdominal cavity), dizziness and fainting. Eventually the individual is likely to go into shock - this is a potentially fatal condition where there is insufficient blood circulating around the body.

Treatment

Although in a number of instances implantation of the ectopic embryo is rejected by the body and naturally removed, medical attention is often required.

If an ectopic pregnancy is suspected then an ultrasound will usually be carried out to detect the status and location of the pregnancy. However, in the earlier stages of pregnancy the tiny embryo may not be detected by this method and so in this case the levels of the pregnancy hormone HCG will be regularly monitored. This will indicate whether the pregnancy is implanted in the womb or elsewhere as HCG levels will continue to increase during a normal pregnancy but level off if the pregnancy is ectopic.

Once an ectopic pregnancy has been identified there are really two options for treatment. The first is only suitable for some early, unruptured ectopic pregnancies and is in the form of an injection of the drug Methotrexate. This avoids the need for surgical intervention by stopping the division of cells causing the pregnancy to halt and be removed by the body. After administration levels of HCG are monitored to ensure termination has been successful.

If treatment using Methotrexate is not deemed suitable then surgery will be needed. Many can be treated via a laparoscopy (keyhole surgery) that removes the pregnancy. However, if this is not possible or if the fallopian tube has ruptured or needs to be removed then a laparotomy may be carried out. This will involve open surgery carried out through a small incision made in the abdominal area.

Outcome

If you experience an ectopic pregnancy there is a 10-20% chance that further pregnancies will also be ectopic. However, for the majority of women it is possible to go on to have further pregnancies that are successfully carried to term, even if the encasing fallopian tube has to be removed. You should always talk to your doctor if you have any questions about possible effects on your fertility or if you are planning to start trying to conceive again.

The loss of a pregnancy whether ectopic or otherwise is a very distressing event. After treatment for an ectopic pregnancy it is important to grieve for your loss - talking to your partner and close friends will help you through this difficult time and help you prepare yourself mentally and physically for another pregnancy if that is what you wish.