What is it?
An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb – usually in the fallopian tube, more rarely in an ovary or in the cervix. It happens in approximately one out of every 90 pregnancies in the UK.
It's thought that risk factors include suffering from pelvic inflammatory disease (or PID, which can occur as a result of chlamydia), smoking and having experienced an ectopic pregnancy previously. However, sometimes none of these risk factors are present.
The cause of ectopic pregnancy is simply that the fallopian tube isn't working properly. Normally, tiny hair-like structures inside the tube, called cilia, push the fertilised egg into the uterus, but if the tube is damaged for any reason, it might fail to do its job.
Women who suffer an ectopic pregnancy are unlikely to know straight away. A pregnancy test might show positive, even though the egg has implanted in the wrong place, and many symptoms of early pregnancy can initially occur, including tender boobs and nausea.
Unfortunately, an ectopic pregnancy simply can not survive and the egg can never develop into a baby. In most cases, the symptoms of an ectopic pregnancy will show themselves early on (between five weeks and 14 weeks). But occasionally, there will be no symptoms, and the ectopic pregnancy won't be discovered until the first scan.
Early symptoms are likely to include vaginal bleeding (the blood might be bright red, or dark red in colour, and can be mistaken for a period, meaning some women are unaware of the pregnancy), and also abdominal pain, which occurs just on one side. The pain might be mild, or it might be severe and unrelenting, unlike the normal cramps associated with early pregnancy.
Other symptoms can include pain in the bowel (when going to the loo, for example), diarrhoea and vomiting, and also pain in the tip of your shoulder. It's thought the shoulder pain happens because the internal bleeding irritates a nerve that runs through the diaphragm, and the pain is deferred.
Occasionally, if an ectopic pregnancy is not discovered, the fallopian tube can rupture, causing dangerous internal bleeding. This is a medical emergency and will require immediate treatment, so call 999.
The symptoms include:
• Dizziness or lightheadedness
• Nausea and/or diarrhoea
• Sudden and severe abdominal pain
• Pale skin
• Increased heart rate
If you suspect an ectopic pregnancy for any reason, go and see your GP.
What will happen?
If you show symptoms of an ectopic pregnancy early on, you will be given a blood test, to check your hCG hormone levels, and also a vaginal ultrasound. These things should confirm whether your pregnancy is ectopic. Sometimes a laparoscopy (when a small camera is inserted via an incision in the abdomen) will be needed.
If you have low levels of hCG, and you are experiencing only mild symptoms, your doctor might advise that you just wait it out – it's likely that the egg will die, and then be absorbed into your own body tissue. There is a small risk that the pregnancy could still result in the rupture of a tube, but you'll be monitored very closely, with regular blood tests and scans.
If the doctor believes intervention is required to end the ectopic pregnancy, and if the pregnancy is still in its early stages, you might be given a drug called methotrexate, which will be injected into your bottom (usually one dose, occasionally two). People with liver or kidney disease, diabetes and anaemia are unable to take the drug.
For those who can take it, it can have some side effects, including dizziness, nausea, diarrhoea and mouth ulcers. It'll also cause abdominal pain, which will last for one or two days. You'll be monitored closely after taking the medicine.
Most commonly, an ectopic pregnancy is ended with keyhole surgery. The surgeon will make small cuts in the abdomen, and use a tiny camera and instruments to locate and remove the egg, and repair the fallopian tube if necessary.
If you have suffered a fallopian tube rupture, you'll need emergency surgery to stop the bleeding and repair the damage. Occasionally, the fallopian tube will need to be removed, and the surgeon will speak to you about this. After either procedure, you might need to stay in hospital for several days, and full recovery could take a month or more.
What happens next?
For women who were unaware they were pregnant, an ectopic pregnancy can be quite a shock. For those who knew they were pregnant, and had deliberately been trying, an ectopic pregnancy can be not only shocking but devastating.
It's normal to feel a sense of grief after an ectopic pregnancy, particularly if you thought you had succeeded in creating a longed for baby. You might feel angry, depressed or just terribly sad. Losing a baby in this way is no less traumatic than any other way, so allow yourself to grieve and seek help.
Once you have been treated for an ectopic pregnancy, you should, if you feel the need, ask your GP about local counselling services available to you. Your doctor should also discuss with you any implications that have arisen as the result of a damaged (or removed) fallopian tube.
Many women who experience an ectopic pregnancy do go on to conceive and give birth to healthy babies. Your doctor should talk to you about when it is safe/sensible to try to conceive again – generally it is advisable to wait until you have had two full menstrual cycles, but if you were given methotrexate, you might need to wait a little longer.
For some women whose fallopian tubes are damaged, IVF might be necessary following an ectopic pregnancy.
The Ectopic Pregnancy Trust offers advice, information and support following ectopic pregnancy and other early pregnancy complications. Helpline: 020 7733 2653.
Cruse is an organisation offering support to people suffering from bereavement. Visit the website to find a local Cruse service, or call the helpline: 0844 477 9400.
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