Ectopic pregnancy is a serious medical condition that occurs when a fertilized egg implants outside the uterus, usually in the fallopian tube. This can lead to serious complications and requires immediate medical attention. In this article, we will discuss the symptoms, causes, diagnosis, treatment, complications, and prevention of ectopic pregnancy.
Ectopic pregnancy symptoms
- missed period,
- nausea, and
- breast tenderness.
Symptoms of an ectopic pregnancy normally appear between weeks 4 to 10 of the pregnancy, often two weeks after a missed period, if you have regular periods.
One-sided abdominal pain: You may expereince pain on one side of your abdomen which can be persistent and severe.
Vaginal bleeding: Vaginal bleeding is often a different type of bleeding than your regular period. It could be lighter, or darker, than usual, and is sometimes more watery than your regular period. It is often described as looking like prune juice. Some women often mistake this bleeding for their regular period and do not realise that they are pregnant.
Shoulder tip pain: Shoulder tip pain is felt where your shoulder ends and your arm begins. It is not known exactly why shoulder tip pain occurs, but it is a sign that the ectopic pregnancy is causing internal bleeding. The bleeding is thought to irritate the phrenic nerve, which is found in your diaphragm (the muscle that is used during breathing and separates your chest cavity from your abdomen). The irritation to the phrenic nerve causes referred pain in the shoulder blade. Referred pain is pain that is felt in one part of the body but originates in another part.
Bowel pain: You may experience pain when passing urine, or stools (faeces).
The most serious symptom of an ectopic pregnancy is known as ‘collapse’. This occurs when the ectopic pregnancy has ruptured the fallopian tubes, and is causing dangerous levels of internal bleeding.
People who have experienced collapse describe it as feeling light-headed and faint, often accompanied by a feeling of ‘something being very wrong’. You may also:
- feel sick,
- have an increased heart rate,
- look pale, and
- have diarrhoea.
If your fallopian tubes rupture, you will need emergency surgery to prevent blood loss.
More than 50% of women who have an ectopic pregnancy experience no symptoms at all, until they experience a collapse. If you have had an ectopic pregnancy in the past, and you think you may be pregnant again, you should see your doctor straight away. They will be able to arrange an examination to determine whether or not the pregnancy is ectopic. In rare cases, a ruptured fallopian tube can be fatal but, in the vast majority of cases, treatment is successful.
Causes of ectopic pregnancy
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, typically in the fallopian tube. Here are some of the common causes of ectopic pregnancy:
- Damaged or scarred fallopian tubes: Any damage or scarring of the fallopian tubes can prevent the fertilized egg from passing through to the uterus, causing it to implant and grow in the tube.
- Hormonal imbalances: Changes in hormone levels, especially the hormone progesterone, can affect the ability of the fertilized egg to move through the fallopian tube, increasing the risk of ectopic pregnancy.
- Birth defects: Rarely, a structural abnormality in the uterus or fallopian tube can increase the risk of ectopic pregnancy.
- Previous pelvic or abdominal surgery: Surgeries in the pelvic or abdominal area can cause scarring or adhesions that can affect the movement of the fertilized egg through the fallopian tube.
- Previous ectopic pregnancy: Women who have had an ectopic pregnancy in the past are at an increased risk of having another one.
- Use of assisted reproductive technologies: Women who use fertility treatments, such as in vitro fertilization (IVF), have a higher risk of ectopic pregnancy.
- Contraceptive failure: Women who become pregnant while using a contraceptive method, such as an intrauterine device (IUD), have a higher risk of ectopic pregnancy.
Ectopic pregnancy can occur in any woman of reproductive age who is sexually active, but some women are at higher risk than others. Here are some of the factors that can increase the risk of ectopic pregnancy:
- Previous ectopic pregnancy: If you have had an ectopic pregnancy before, the risk of having another one is increased.
- Age: Women who are older than 35 are at a higher risk of ectopic pregnancy.
- Fertility treatments: Women who have undergone fertility treatments, such as in vitro fertilization (IVF), are at a higher risk of ectopic pregnancy.
- Infections: If you have had a sexually transmitted infection (STI) or pelvic inflammatory disease (PID), you are at a higher risk of ectopic pregnancy.
- Contraceptive failure: If you become pregnant while using a contraceptive method, such as an intrauterine device (IUD), there is a higher risk of ectopic pregnancy.
Diagnosing ectopic pregnancy
Ectopic pregnancy can be difficult to diagnose in the early stages. However, it is important to detect ectopic pregnancy as early as possible to avoid serious complications. Here are some of the tests that may be used to diagnose ectopic pregnancy:
- Pelvic exam: A physical examination of the pelvic region may reveal tenderness or swelling, which can be a sign of ectopic pregnancy.
- Ultrasound: An ultrasound scan can be used to detect the location of the gestational sac and identify whether the pregnancy is inside or outside of the uterus.
- Blood tests: A blood test can measure the level of the hormone human chorionic gonadotropin (hCG) in the blood. If the hCG levels are lower than expected for a normal pregnancy, it may indicate an ectopic pregnancy.
- Laparoscopy: In some cases, a laparoscopy may be used to view the reproductive organs directly and confirm the diagnosis of ectopic pregnancy. During this minimally invasive surgical procedure, a small camera is inserted through a small incision in the abdomen to view the fallopian tubes and ovaries.
It is important to contact your healthcare provider or doctor immediately if you experience any symptoms of ectopic pregnancy, such as abdominal pain, vaginal bleeding, or dizziness. Early diagnosis and treatment can help prevent serious complications.
Ectopic pregnancy treatment
Surgery: Surgery is the most common treatment. It involves removing the embryo, usually using minimally invasive surgery, or ‘keyhole’ surgery, where a small incision is made. If your fallopian tube has been damaged, it may also need to be removed.
Medication: If the ectopic pregnancy is diagnosed early enough, the pregnancy can be stopped using a medicine called methotrexate. Methotrexate works by killing the cells of the ectopic pregnancy. However, it can often cause side effects, such as abdominal pain. If methotrexate is recommended for you, your condition will need to be closely monitored by having regular blood tests. Methotrexate is injected into the muscles, or directly into the fallopian tube under the guidance of ultrasound, or keyhole surgery.
Expectancy (‘wait and see’): If your ectopic pregnancy symptoms are mild, or you have no symptoms at all, your specialist may recommend delaying treatment to see how the ectopic pregnancy develops. Many ectopic pregnancies die without the need for medical intervention. However, you will require frequent blood tests, and close observation, to monitor how the ectopic pregnancy is progressing.
Emergency surgery: If your fallopian tube has ruptured, you will need emergency surgery. The surgeon will make an incision in your abdomen (a laparotomy) in order to stop the bleeding. Sometimes, the fallopian tube can be repaired, but it often has to be removed.
Complications of ectopic pregnancy
If treatment for an ectopic pregnancy is delayed, your fallopian tubes will stretch. The more treatment is delayed, the more likely it is that your fallopian tubes will be damaged, leading to an increased likelihood of further ectopic pregnancies in the future.
If you have an ectopic pregnancy, you may feel depressed or sad. You may also worry about your chances of having a healthy pregnancy in the future. However, women with only one fallopian tube still have a good chance (50%) of having a normal, healthy pregnancy in the future.
If both fallopian tubes are damaged, or removed, you may want to consider having IVF treatment (in-vitro fertilisation) to help you have a baby.
Preventing ectopic pregnancy
While there is no guaranteed way to prevent ectopic pregnancy, there are steps that can be taken to reduce the risk. Here are some ways to prevent ectopic pregnancy: