What Is An Ectopic Pregnancy?

In a normal pregnancy, the fertilised egg attaches to the lining of the uterus. An ectopic pregnancy occurs when a fertilised egg implants and grows outside the uterus. These pregnancies mostly occur in the fallopian tubes, although they can also occur in other areas of the body such as the ovary, abdominal cavity, or the cervix. In the UK, around 1 in every 90 pregnancies is ectopic.

A fertilised egg cannot survive outside the uterus. If left to grow, it may cause the fallopian tube to rupture or damage nearby organs. This can cause a life-threatening loss of blood. 

Unfortunately, it is not possible to save the pregnancy and urgent treatment will be required to remove the embryo. Medication may be sufficient in the early stages of pregnancy although surgery will be required in the later stages.

What Are The Symptoms Of An Ectopic Pregnancy?

In the early stages of pregnancy, women with an ectopic pregnancy will generally have the usual early signs or symptoms of pregnancy - a missed period, breast tenderness and nausea. Symptoms of an ectopic pregnancy usually tend to develop between the 4th and 12th week of pregnancy. These symptoms include:

• Pelvic pain.
• Vaginal bleeding, which starts off with light bleeding.
• Pain in the tip of your shoulder (if blood leaks from the fallopian tube).
• An urge to have a bowel movement.

If the fallopian tube ruptures, it is likely to cause heavy bleeding. This can cause a sharp, sudden, and intense pain in your abdomen and you may feel lightheaded, faint or go into shock. You should seek urgent medical attention if you experience any of these symptoms.

How Are Ectopic Pregnancies Treated?

Three main options are available for treating an ectopic pregnancy. Based on your symptoms and any test results, your doctor will discuss your most suitable treatment option. These may include:

• Expectant management: If you don’t have urgent symptoms, you may be carefully monitored to see if the embryo (fertilised egg) dissolves by itself. If it does not, you will need either medical or surgical treatment.
• Medicine: You may be given an injection of a potent medicine called methotrexate which stops the embryo from growing. This is usually possible in the earlier stages of ectopic pregnancy. You should not try and get pregnant within 3 months of taking this medication as it can damage your baby.
• Surgery: In urgent cases or when pregnancy is more advanced, a laparoscopy (keyhole surgery) will need to be performed under general anaesthetic to remove the embryo. The affected fallopian tube is usually also removed. This treatment may reduce your chances of being able to fall pregnant in the future. 

What Are The Risk Factors For Ectopic Pregnancy?

The exact cause of ectopic pregnancy is unknown, although, in most cases, it appears to be associated with damaged or blocked fallopian tubes. Hormonal imbalances or abnormal development of the fertilised egg may also play a role. The following factors may increase your risk of having an ectopic pregnancy:

• Pelvic inflammatory disease (PID), which is usually caused by a sexually transmitted infection (STI), causes inflammation of the female reproductive system. Untreated gonorrhoea or chlamydia can cause scar tissue and abscesses (pockets of infected fluid) to form in the reproductive tract, including the fallopian tubes.
• Previous ectopic pregnancy. This can scar the fallopian tubes and increases your risk of having another ectopic pregnancy by around 10%
• Previous unsuccessful surgery on your fallopian tubes – such as a female sterilisation procedure.
• Hydrosalpinx, which is fluid blockage and swelling in your fallopian tubes.
• Fibroids. These benign (noncancerous) growths can block the fallopian tubes.
• Fertility treatment, such as IVF, can increase the risk of ectopic pregnancy
• Becoming pregnant while using an intrauterine device (IUD). It is rare to become pregnant while using an IUD, but you are likely to have an ectopic pregnancy if you do.
• Smoking just before you get pregnant increases your risk of an ectopic pregnancy.
• Increasing age. Women over 35 are most at risk of having an ectopic pregnancy.

Can You Prevent An Ectopic Pregnancy?

It is not always possible to prevent an ectopic pregnancy. However, you can reduce your risk of an ectopic pregnancy by protecting yourself against sexually transmitted infections, which can lead to scarring of the fallopian tubes. You can avoid getting a STI by using a condom when you are not actively trying to fall pregnant. You should also stop smoking.

If you have had a previous ectopic pregnancy, it is important to advise your doctor. Your pregnancy should be monitored from an early stage to ensure that the embryo has implanted successfully in the uterine wall and not in the fallopian tube.