An ectopic pregnancy is a medical emergency in which a fertilized egg implants and grows outside the main cavity of the uterus. The most common site (in over 95% of cases) is in a fallopian tube. As the pregnancy grows, it can cause the tube to rupture, leading to severe internal bleeding, which is life-threatening.
A pregnancy cannot survive outside the uterus and must be treated to protect the health and future fertility of the woman.
Common Symptoms
Early on, an ectopic pregnancy may feel like a normal pregnancy with a missed period and breast tenderness. Warning signs usually appear between weeks 4 and 12 of pregnancy.
Early Warning Signs
- Pelvic or Abdominal Pain: Often sharp, stabbing, or cramping. It may be on one side.
- Vaginal Bleeding: Different from a period, often lighter, darker, or more watery (“prune juice” appearance).
- Shoulder Tip Pain: A strange pain where your shoulder ends and your arm begins. This is a serious sign of internal bleeding irritating nerves.
- Pain with Bowel Movements or Urination.
Signs of a Rupture (Medical Emergency – you must go to A&E immediately)
- Sudden, Severe, Sharp Abdominal/Pelvic Pain.
- Feeling Faint, Dizzy, or Lightheaded.
- Pale, Clammy Skin, Rapid Heartbeat.
- Collapse or Fainting.
Causes & Risk Factors
An ectopic pregnancy happens when the fertilized egg’s journey to the uterus is blocked or slowed.
Risk Factors Include
- Previous Ectopic Pregnancy.
- Pelvic Inflammatory Disease (PID) or Chlamydia/Gonorrhoea Infection (which can scar the tubes).
- Previous Pelvic or Tubal Surgery (including sterilisation reversal).
- Endometriosis.
- Conceiving with an Intrauterine Device (IUD) in place.
- Smoking.
- Fertility Treatments (IVF).
However, about half of women with an ectopic pregnancy have no known risk factors.
Diagnosis
If an ectopic pregnancy is suspected, you will have immediate tests
- Pregnancy Test (hCG Blood Test): Measures the pregnancy hormone. In an ectopic, hCG levels often rise more slowly than in a normal pregnancy.
- Transvaginal Ultrasound Scan: To locate the pregnancy. If no pregnancy is seen inside the uterus by the time the hCG reaches a certain level, an ectopic is strongly suspected.
- Pelvic Examination: To check for tenderness or a mass.
Treatment Options
Treatment is urgent and depends on your symptoms, the size of the pregnancy, and your hCG level.
Expectant Management (Watchful Waiting)
- Very early, stable ectopics with low and falling hCG levels.
- Close monitoring with blood tests and scans until hCG drops to zero. Only used in select cases.
Medication (Methotrexate)
- Stable ectopics with no rupture, low hCG, and small size.
- An injection that stops the pregnancy cells from growing, allowing the body to reabsorb them.
- Requires careful follow-up with blood tests for weeks until hCG is zero. Avoid pregnancy, alcohol, and certain vitamins for several months.
Surgery
- Laparoscopic (Keyhole) Salpingectomy: Removal of the affected fallopian tube. This is the most common and recommended surgery, especially if the tube is stretched or ruptured, to prevent a repeat ectopic in the same tube.
- Laparoscopic Salpingostomy: An attempt to remove the pregnancy while preserving the tube. This carries a higher risk of some tissue remaining, requiring further monitoring or treatment.
- Emergency Laparotomy (Open Surgery): Required for severe rupture and life-threatening bleeding to stop the bleeding quickly.
Aftercare & Long-Term Considerations
Physical Recovery
- Physical healing from surgery or medication takes a few weeks. Avoid heavy lifting and strenuous exercise as advised.
- You will have follow-up blood tests to ensure hCG levels return to zero.
Emotional Recovery
- This is a significant loss. Feelings of grief, sadness, and anger are normal. Allow yourself time to heal emotionally.
- Seek support from your partner, family, friends, or a professional counsellor.
Future Fertility
- Your future chance of a healthy pregnancy in your uterus is good. If you have one healthy tube, conception is still possible.
- Your risk of having another ectopic pregnancy is higher (about 10%).
- You should see your gynaecologist early in any future pregnancy for an early scan (around 6-7 weeks) to confirm the pregnancy is in the uterus.
eGynaecologist Advice
- You must seek immediate emergency medical care (A&E/ED) if you have a positive pregnancy test and experience sudden, severe abdominal pain, shoulder tip pain, dizziness, or fainting. This can be a life-threatening situation.
- You should contact your Early Pregnancy Unit or your gynaecologist immediately if you are pregnant and experience any unusual one-sided pain or abnormal bleeding for an urgent assessment.
- You must attend all follow-up appointments and blood tests after treatment for an ectopic pregnancy to ensure it has been completely resolved and seek early pregnancy scan from your gynaecologist in all your future pregnancies.
Frequently Asked Questions
Could the pregnancy have been saved or moved to the uterus?
No. This is not possible with current medical science. The focus of treatment is to safeguard your health and future fertility.
Will I be able to get pregnant again?
Yes, most women can. Your fertility depends on the health of your other tube and any other factors. A single ectopic pregnancy does not mean you are infertile.
How long should I wait before trying to conceive again?
After methotrexate, you must wait at least 3 months. After surgery, it’s usually advised to wait until after your next normal period (for dating purposes) and when you feel emotionally ready.
Did I do something to cause this?
No. Nothing you did or didn’t do caused the ectopic pregnancy. It is a chance occurrence, often with no clear cause.
Will I go through the menopause earlier because of this?
No. Removing one fallopian tube does not affect your ovarian reserve or hormone levels. You will still ovulate from both ovaries.
