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Ectopic Pregnancy

ectopic pregnancy

An ovum (egg) is released from an ovary into a Fallopian tube. This is called ovulation and usually occurs once a month about halfway between periods. Sperm can survive in the Fallopian tubes for up to five days after having sex. A sperm may then combine with the ovum (fertilisation) to make an embryo. The tiny embryo is swept along a Fallopian tube to the uterus by tiny hairs (cilia). It normally attaches to the inside lining of the uterus and develops into a baby.

Where does an ectopic pregnancy develop?

Most ectopic pregnancies occur when a fertilised egg attaches to the inside lining of a Fallopian tube (a tubal ectopic). Rarely, an ectopic pregnancy occurs in other places such as in the ovary or inside the abdomen.

What are the problems with an ectopic pregnancy?

A tubal ectopic pregnancy never survives. The pregnancy often dies after a few days. About half of ectopic pregnancies probably end like this. Sometimes there is slight pain and some vaginal bleeding like a miscarriage.

The pregnancy may grow for a while in the narrow Fallopian tube. This can stretch the tube and cause symptoms. This is when an ectopic pregnancy is commonly diagnosed. The narrow Fallopian tube can only stretch a little. If the pregnancy grows further it will normally rupture the Fallopian tube. This can cause heavy internal bleeding and pain. This is a medical emergency.

What are the symptoms of an ectopic pregnancy?

Symptoms typically develop around the 6th week of pregnancy. This is about two weeks after a missed period if you have regular periods. However, symptoms may develop at any time between 4 and 10 weeks of pregnancy.

Symptoms include one or more of the following.

  • Pain on one side of the lower abdomen.
  • Vaginal bleeding often occurs, but not always.
  • Shoulder-tip pain may develop. This is due to some blood leaking into the abdomen and irritating the diaphragm.
  • If the Fallopian tube ruptures and causes internal bleeding, you may develop severe pain or 'collapse'. This is an emergency as the bleeding is heavy.
  • Sometimes there are no warning symptoms before the tube ruptures. Therefore 'collapse' due to sudden heavy internal bleeding is sometimes the first sign of an ectopic pregnancy.

Who gets ectopic pregnancy?

Ectopic pregnancy can occur in any sexually active woman. The chance is higher than average in the following 'at-risk' groups:

  • If you have already had an ectopic pregnancy you have a slightly higher chance that a future pregnancy will be ectopic.
  • If you have kinking, scarring, damage, or other abnormality of a Fallopian tube.
  • If you have had a previous infection of the uterus or Fallopian tube (pelvic inflammatory disease).
  • Previous sterilisation operation.
  • Any previous surgery to a Fallopian tube or nearby structures.
  • If you have endometriosis (a condition of the uterus and surrounding area).
  • If you use an intrauterine contraceptive device (coil).
  • If you are using assisted conception (some types of infertility treatments).
  • The risk of ectopic pregnancy increases in women over the age of 35 years and also in smokers.

How is ectopic pregnancy confirmed?

  • A urine test can confirm that you are pregnant.
  • An ultrasound scan, usually a transvaginal (internal) scan which is not painful and shows good views of the Fallopian tubes.
  • Blood tests that show changes in the pregnancy hormones - human chorionic gonadotropin (hCG).

What are the treatment options for ectopic pregnancy?

Ruptured ectopic pregnancy

Emergency surgery is needed if a Fallopian tube ruptures with heavy bleeding. The ruptured Fallopian tube and remnant of the early pregnancy are then removed. The operation is often life-saving.

Early ectopic pregnancy - before rupture

Ectopic pregnancy is most often diagnosed before rupture. Your doctor will discuss the treatment options with you. These may include the following:

Surgery Removal of the tube (either the whole tube or part of it) and the ectopic pregnancy is most commonly performed by a laparoscopic operation. Salpingectomy (removal of the Fallopian tube containing the ectopic pregnancy) is performed if the other tube is healthy. Salpingotomy (removal of only a section of the tube with the ectopic pregnancy in) is performed if the other tube is unhealthy.

Medical treatment Medical treatment of ectopic pregnancies is now more common and avoids the need for surgery. A medicine called methotrexate is often given, usually as an injection. It works by killing the cells of the pregnancy growing in the Fallopian tube. It is normally only advised if the pregnancy is very early.

If your blood group is rhesus negative, then you will need an injection of anti-D immunoglobulin. All pregnant women have a blood test to determine whether they are rhesus positive or negative. The injection of anti-D immunoglobulin simply prevents you from producing antibodies, which can be harmful in future pregnancies, if you are rhesus negative.

A gynaecologist will advise on the pros and cons of each treatment with you. One common question is - 'What is the chance of having a future normal pregnancy after an ectopic pregnancy?' Even if one Fallopian tube is removed, you have about a 7 in 10 chance of having a future normal pregnancy.


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