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Ectopic Pregnancy
An ectopic pregnancy is a pregnancy that develops outside the uterus (womb). It almost always happens in a fallopian tube. Because of this, it is often called a ‘tubal pregnancy’. In rare cases, an ectopic pregnancy can occur in an ovary, in the cervix or in the abdomen. Ectopic pregnancy is common and affects around 1 in 100 pregnancies.
In some people, it can be a life-threatening condition and sadly is the most common cause of death in early pregnancy. The Ectopic Pregnancy Trust reports that on average there are two deaths every year due to ectopic pregnancy in the UK and Ireland. This is an avoidable cause of death if picked up early enough. Because of this it is critical that if you have any signs of ectopic pregnancy, to get an urgent medical assessment.
What are the signs and symptoms of an ectopic pregnancy?
Women with an ectopic pregnancy may have irregular bleeding and pelvic or abdominal pain. Often, the pain is just on one side and can vary from dull to sharp. It can also cause shoulder tip pain (an unusual sharp / tingling / aching pain on top of your shoulder where it meets your arm). In addition, an ectopic pregnancy can make you feel like you suddenly need the toilet (urgency), it can also cause diarrhoea and/or cause pain when you wee or poo.
If you have any of these symptoms and you think you might be pregnant, it is important to seek urgent medical advice.
Abdominal or pelvic pain
Shoulder tip pain
Light bleeding or brown vaginal discharge (often after a missed period)
Nausea
Feeling faint, dizzy or light headed
Discomfort or urgency going to the toilet
Symptoms frequently happen five to seven weeks after the last normal menstrual period.
Women may develop other general signs of pregnancy, like sore breasts and nausea. Because the symptoms of an ectopic pregnancy can be like those of many other conditions, it can be easy to ignore them or not get an early diagnosis. Waiting to seek treatment can result in complications such as internal bleeding, though, so it is very important to try to avoid this and seek help as early as possible.
What causes an ectopic pregnancy?
A fertilised egg normally moves down a fallopian tube and into the uterus. However, if the tube is blocked, the egg can get stuck. The blockage might be from an infection or scar tissue. If the fertilised egg is unable to reach the uterus, it begins to develop in the tube. If the pregnancy continues to grow inside the tube, it may damage it, or even cause it to burst. In some cases, this can cause internal bleeding and pain.
Who is at risk for an ectopic pregnancy?
Ectopic pregnancy can happen to any woman, but there are some factors that can put you at higher risk:
Smoking
Older age (most ectopic pregnancies happen with women in their 30’s and 40’s)
Coil / IUS use
Previous tubal surgery
Fertility treatment
Previous pelvic inflammatory disease or sexually transmitted infection – this can cause scarring in the pelvis
How is an ectopic pregnancy diagnosed?
Usually, an ectopic pregnancy is diagnosed by measuring the level of beta hCG (human chorionic gonadotrophin) in the blood. This is a hormone that is released in pregnancy. A transvaginal ultrasound scan is also needed for the diagnosis. This scan is a safe procedure where a probe is put inside the vagina to get images in and around the uterus. This will often indicate whether a fertilised egg is growing in one of the fallopian tubes. Sometimes an ectopic pregnancy is tricky to spot. Rarely, a laparoscopy is needed to understand where the pregnancy is developing. This is a small operation where a narrow tube for a camera probe is inserted into the abdomen through a small cut.
How is an ectopic pregnancy treated?
Unfortunately, an ectopic pregnancy can never be saved. Instead, it will need to be treated in one of several ways. Depending on the investigation results, options for treatment will be offered. Usually, this depends on how far along the pregnancy is, whether the fallopian tube has broken open (ruptured), and the hormone levels. Treatments include:
Allowing the ectopic pregnancy to heal and the body to absorb it on its own. This is known as ‘expectant management’. It requires careful monitoring to check that the pregnancy bHCG hormone is falling
Using a medicine called methotrexate to stop the pregnancy from growing further
With surgery (usually laparoscopy, or keyhole surgery). In rare cases, a larger operation (open surgery) is needed to remove the ectopic pregnancy.
Your doctor should help you to make the best decision regarding management based on your symptoms and signs, your past history, as well as blood tests and scans. This should consider what is safest for you at that time as well as what is best for your recovery and future fertility if that is important to you.
How will I feel afterwards?
For some women an ectopic pregnancy happens after months of trying to have a baby. For others they learn they are pregnant and rushed into surgery in the same hospital visit. Some women suffer extreme pain. Some even have life threatening complications. No matter what your situation, an ectopic pregnancy can cause a number of difficult emotions and can have a huge impact on you and your partner.
There are a number of common feelings after the discovery and treatment of an ectopic pregnancy:
Sadness, loss, grief
about the pregnancy
for the baby
for your own health
Shock
finding out about the ectopic pregnancy
about what happened
about being unwell
Frustration, anger, blame
that this happened to you
that you may have to wait to have more tests, or to try for a further pregnancy
if you did not felt listened to or if you felt you were not cared for well
thoughts of blame on yourself or others for what happened
Guilt, embarrassment, shame
that it was somehow your fault
that you could not have a healthy pregnancy
that there is something wrong with you
Worry, fear and anxiety
about the future,
your fertility
whether you can get pregnant again
if you could have another ectopic pregnancy again
Jealousy, envy
of others that seem to have no problems with pregnancy
Loneliness
as not many people you know will understand how you feel
as you may not have told people that you were pregnant
as it can be difficult to tell people about your loss
Coping after an ectopic pregnancy will be different for all women (and their partners).
It might mean coming to terms with the potential impact on future fertility, on the loss of your baby or in some extreme cases with the awareness that you could have lost your own life. Some women also suffer from PTSD from the experience.
The important thing to do is to get help if you need it. Talking with your partner, friends and family can help. If you feel you are struggling, you can talk to your GP or find support online at recommended websites such as The Ectopic Pregnancy Trust and The Misscarriage Association.
While ectopic pregnancies are very difficult on the women suffering from it, it is also important to recognise the impact on your partner and family. They may have ongoing fears or even trauma, especially if there was a risk to your life. Ensure that along with help for yourself, they also get the help they need.
Can I get pregnant after an ectopic pregnancy?
A huge question for a lot of women after an ectopic pregnancy is “can I get pregnant and have a healthy pregnancy”? The great news is that yes, for many women it is possible to still have a healthy full term baby after an ectopic pregnancy. However, your odds are higher of having another ectopic pregnancy. Especially if your pregnancy was ectopic because of an oddly shaped fallopian tube, or if you have scarring from surgery or a sexually transmitted infection. A history of infertility can also be a major factor.
The most important thing is to understand why you had an ectopic pregnancy in the first place and then speak with your doctor about how you can avoid it in the future. This may require medical treatment or surgery, especially if there is something blocking your fallopian tube. Your doctor will work with you to establish what can be done and to discuss your fertility options with you.
If you do become pregnant again, it is natural for anxiety to be heightened after a previous pregnancy loss. It is very important to tell your doctor and midwives that you have had an ectopic pregnancy in the past. This should help them to support you in your pregnancy and will ensure you are considered a high risk case, so they monitor you more closely - working hard to keep you and your baby safe.
If you go on to have a future pregnancy after an ectopic pregnancy, we are also working on further options for support here at Kensa Health. This includes our soon to be released course, Pregnancy after previous pregnancy and baby loss, and our corresponding online support community.
This can be a very emotionally difficult time and that can take a toll on you and your partner’s mental health. Please continue to seek emotional and mental health support if you need to.
Amy’s Story
Amy is 35 years old and the mother of two children.
“One weekend I woke up with right-sided tummy pain. Initially, it was mild, and I was able to ignore it. However, the pain worsened over the course of the next couple of days. I then started to have some vaginal bleeding. I was nearly two months late for my period, which was unusual as I am normally quite regular. After the pain carried on, I started to worry I might have appendicitis so went to see my GP. A pregnancy test was positive. They sent me to the hospital where I had a blood test and a transvaginal ultrasound. This showed an ectopic pregnancy developing in my right fallopian tube. After the doctor explained to me the problem, I went on to have laparoscopic surgery to remove the pregnancy. For many months afterwards, I struggled. I felt low and tearful most days. I then went back and spoke to my GP, who put me in touch with the Ectopic Pregnancy Trust.3 The charity was able to offer guidance and support. Slowly, I started to feel more like myself again.”