Ectopic pregnancy

An ectopic pregnancy is one that is growing in the wrong place, usually in the fallopian tube. Occasionally, an ectopic pregnancy can also be found on the ovary, in a scar from a previous caesarean section or in other parts of the abdomen.

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What is an ectopic pregnancy?

It is usual for an egg and sperm to meet and for conception to begin in a fallopian tube. Normally the fertilised egg continues its journey into the uterus but in an ectopic pregnancy, the fertilised egg stays inside the fallopian tube.

The uterus is able to stretch and grow with the pregnancy. The fallopian tube cannot grow and expand in the same way, so an ectopic pregnancy cannot continue to develop. As the pregnancy becomes larger it stretches the tube, which is very painful and can cause the tube to tear or burst. If this happens there can be serious internal bleeding and urgent surgery may be needed.

Sometimes an ectopic pregnancy will shrink on its own and miscarry.

About one or two in every one hundred pregnancies are ectopic. Often no reason is found, but tubal pregnancy is more common in the following situations:

  • after fertility treatment such as in-vitro fertilisation (IVF)
  • if there is a history of pelvic infection
  • in women with damaged fallopian tubes
  • in women who have had previous surgery (such as caesarean section, ovarian cysts or appendix removed)
  • in women who become pregnant while using an IUD or a progestogen only pill.

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How is an ectopic pregnancy treated?

An ectopic pregnancy must be treated to stop it from growing. If it is not treated it could lead to serious internal bleeding and occasionally even death.

There are three options for treatment depending on the severity of your condition. They are:

  • surgery
  • medication
  • wait and see.

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Surgery

Surgery is recommended if the doctor believes you are bleeding internally or that you are likely to bleed internally. This decision is based on your symptoms, the examination findings and test results.

Sometimes you may have internal bleeding or pain but it is not certain that you have an ectopic pregnancy. The bleeding and pain could be due to something else entirely, such as an ovarian cyst or appendicitis. Surgery may still be necessary.

The surgery is usually done using keyhole surgery (laparoscopy).

A laparoscopy is done under a general anaesthetic. A small cut is made in your abdomen.  A tiny telescope is inserted into your abdomen to view your internal organs. If an ectopic pregnancy is found, it will be removed. Often it is necessary to remove part or all of the fallopian tube to control the bleeding.

Occasionally the surgeon will need to perform ‘open’ surgery because they need to see more of what is going on inside your body. If this happens you will have a bigger scar and may take a little while longer to recover.

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Medication

If the doctors think that your risk of internal bleeding is very low, you may have the option of using medicine to stop the pregnancy growing. The injection takes time to work and is not always successful. Some women need repeated treatment or even surgery to completely end an ectopic pregnancy.

Treatment using medication should only be used if the ectopic pregnancy is very small and there is no sign that you have internal bleeding.

Important information

  • The medication is not safe to use if you are breastfeeding.
  • It is important not to become pregnant again within three to four months of using it.
  • It may not be safe for women with some medical conditions.
  • You will have a blood test to check your liver and kidney function before starting treatment.
  • After medication treatment you will need to have further blood tests and checkups.

It is important to make sure that the pregnancy has ended because until this happens it is still possible for the remaining pregnancy to cause serious internal bleeding, which may need surgery.

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Wait and see 

If it seems likely that your ectopic pregnancy is miscarrying, the doctor may suggest that you wait and see. If this is the case, you will typically have very little pain, there will be no definite ectopic pregnancy on ultrasound examination and your pregnancy hormone levels will be falling. Follow-up blood tests will be arranged until the pregnancy has completely ended, to be sure that there is minimal risk of any remaining pregnancy tissue causing internal bleeding.

You need to attend an emergency service if you have any of the following symptoms while you are waiting for treatment:

  • severe abdominal pain
  • shoulder tip pain
  • much heavier bleeding
  • dizziness or spells of fainting.

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What does this mean for future pregnancies?

If you have already had an ectopic pregnancy you have an increased risk of having another one in the future. This is partly because the underlying problem that caused the first ectopic pregnancy may still be there and also because the ectopic may have damaged or scarred the fallopian tube, or the tube may have been removed in surgical treatment. Both ectopic pregnancy and its causes may affect fertility. Your doctor will give you the best information about your individual circumstances.  

For medical reasons we usually recommend waiting two months after surgery and three to four months after medication before getting pregnant again. Because it is possible to become pregnant again straight away, you will need to use contraception. We advise all women wanting to conceive to take folate tablets one month before getting pregnant and for three months into the pregnancy.

It is recommended that anyone who has had an ectopic pregnancy has an early ultrasound examination, at around five and a half to six weeks in all future pregnancies to check that the pregnancy is in the right place.

After an ectopic pregnancy, as with a miscarriage, you may have mixed feelings about becoming pregnant again. You may find it useful to speak about your concerns with your GP or a counsellor.

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The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.

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