This early pregnancy health problem can be devastating for those expecting a baby, and it’s important that it’s identified quickly.
What is an ectopic pregnancy?
An ectopic pregnancy is when a fertilised egg implants itself outside of the womb – often in one of the fallopian tubes. It affects about one in 80 pregnancies.
‘Ectopic means “an out-of-place pregnancy”,’ says Alex Peace-Gadsby, chairman of the Ectopic Pregnancy Trust, a charity that provides information and support for those affected by the condition.
Normally, an egg is released each month from the ovaries. If fertilised by the sperm, it will travel down the fallopian tube and implant itself into the wall of the uterus, where it will eventually develop into a embryo.
‘But in an ectopic pregnancy, the fertilised egg implants elsewhere – sometimes in the fallopian tube and sometimes outside of the uterus, in the cervix and in the abdomen,’ says Alex. ‘The baby continues to grow inside the tube where it can cause the tube to burst or otherwise severely damage it.’
What are the reasons for an ectopic pregnancy?
Anyone can have an ectopic pregnancy, but it tends to occur more frequently in women affected by the following:
- Pelvic inflammatory disease – an infection of the fallopian tubes often caused by sexually transmitted disease such as chlamydia.
- Endometriosis – when the lining of the womb grows elsewhere in the body, but continue to bleed as a menstrual cycle each month. It can damage fallopian tubes.
- Abdominal or tubal surgery – such as a Caesarean section or operation on your tubes
- Contraceptive coil – it can prevent a fertilized egg implanting in the uterus, but may not stop one in the fallopian tubes.
- Previous ectopic pregnancy – if you’ve had one ectopic pregnancy, it can increase your chances of further ectopic pregnancies.
- Smoking – research by the University of Edinburgh showed that smokers have an increased level of a protein, which can hinder the progress of a fertilised egg down the fallopian tubes.
Symptoms of ectopic pregnancy
An ectopic pregnancy is most likely to be discovered when you’re between five and 10 weeks pregnant. Most women experience symptoms about two weeks after they miss a period.
Symptoms of an ectopic pregnancy can be tricky to pick up because they can present as other problems such as gastroenteritis, miscarriage or even appendicitis.
‘It may feel like period pains. Or it may feel like you're having a miscarriage, with cramping and slight bleeding. Symptoms may come and go, or you may not even feel any symptoms during the early stages,’ says Alex.
Common symptoms include one-sided pain in the belly, and vaginal bleeding different to your normal period. This one would be darker or brighter and occasionally stop and resume.
Seek emergency medical treatment if 'collapse' occurs. That is the most serious symptom meaning one of your fallopian tubes has been split. Call 999 immediately to avoid blood loss. Symptoms of rapture include dizziness, increased heart rate, pale skin and sharp pain in the tummy.
How is an ectopic pregnancy diagnosed?
If you have any abdominal pain or bleeding, don’t hesitate to contact a doctor immediately. ‘If your instincts are screaming at you that something doesn’t feel right, it’s OK to trust them and ask for a reassessment at any time,’ says Alex.
At the hospital or GP surgery, doctors will carry out various tests, including urinary pregnancy tests (as it’s often so early on that you might not even realise you’re pregnant), ultrasound scans and blood tests.
This is to try and identify where the embryo has implanted and whether the pregnancy is viable. The doctor can then make a decision about what will happen next.
Why speedy diagnosis of ectopic pregnancy is vital
Appropriate referrals, speedy investigations and early diagnosis are all vital for helping to improve care and potentially save lives. While uncommon, if ectopic pregnancy is left undiagnosed, it can cause bleeding, pain and can be fatal.
The new quality standard proposed by NICE wants to ensure that women referred for an early pregnancy assessment – either for a suspected miscarriage or ectopic pregnancy – should be given a transvaginal ultrasound scan to look for any problems.
Alex Peace-Gadsby, chairman of the Ectopic Pregnancy Trust, has welcomed the guidelines and reaffirmed the important of emergency scanning when possible, saying, ‘Experiencing an ectopic pregnancy is a very frightening and distressing experience for women and their families. Prompt diagnosis reduces distress levels, enables ladies to have treatment options, can preserve fertility and saves lives.’
Can you treat an ectopic pregnancy?
Sadly, if it’s discovered that you have an ectopic pregnancy, it means the baby cannot be saved.
The most established form of treatment for ectopic pregnancy is called surgical management. This involves performing an operation to remove the ectopic pregnancy while you are under general anaesthetic.
‘There are then two courses of action for the surgeon and the one chosen will depend upon the damage to the affected tube and the condition of the other tube,’ says Alex. ‘If there is a lot of damage or bleeding, the affected tube will be removed (salpingectomy). If the damage is minimal, then the ectopic pregnancy can be removed from the tube by making a small cut, leaving the tube intact (salpingotomy).’
If your ectopic pregnancy is diagnosed early on, you may instead be offered a drug called Methotrexate. This works by inhibiting the growth of the foetus, but is only suitable if your pregnancy hormone levels are still quite low (levels rise the further into your pregnancy you get). This treatment means you can avoid surgery and potentially save your fallopian tube, as you experience bleeding and the embryo leaves the body through the vagina.
Trying to conceive after an ectopic pregnancy
Women are usually advised to wait three months (or two full menstrual cycles) before trying for another baby. This allows any internal inflammation and bruising from the ectopic pregnancy and any associated treatment to heal. You may also need time to process the loss of your pregnancy and work through your grief – something that shouldn’t be rushed.
‘Statistically, the chances of having a future successful pregnancy are very good and 65% of women are healthily pregnant within 18 months of an ectopic pregnancy,’ says Alex. ‘Some studies suggest this figure rises to around 85% over 2 years.’
If you or someone you know has been affected by an ectopic pregnancy, call The Ectopic Pregnancy Trust on 020 7733 2653 or email firstname.lastname@example.org.