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Ectopic pregnancy Content Supplied by NHS Choices
Introduction

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.

The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a?baby and your health may be at risk if the pregnancy continues.

Unfortunately, it's not possible to save the pregnancy. It usually has to be removed using medicine or an operation.

In the UK, around 1 in every 80-90 pregnancies is ectopic. This is around 12,000 pregnancies a year.

This page covers:

Symptoms of an ectopic pregnancy

When to get medical advice

When to get emergency help

How an ectopic pregnancy is treated

Help and support after an ectopic pregnancy

Trying for another baby

What can cause an ectopic pregnancy?

Symptoms?of an ectopic pregnancy

An ectopic pregnancy doesn't always cause symptoms and may only be detected during a routine pregnancy scan.

If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy.

Symptoms can include a combination of:

However, these symptoms aren't necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a?stomach bug.

Read more about the symptoms of an ectopic pregnancy.

When?to get medical advice

Contact your GP or call?NHS 111 if you have a combination of any of the above symptoms and you might be pregnant - even if you haven't had a positive pregnancy test.

An ectopic pregnancy can be serious, so it's important to get advice right away.

Your GP will ask about your symptoms and you'll usually need to do a pregnancy test to?determine if you could have an ectopic pregnancy.

You may be referred to a specialist early pregnancy clinic for further assessment, where an?ultrasound scan and?blood tests may be carried out to confirm the diagnosis.

Read more about ectopic pregnancy tests.

When?to get emergency help

Call 999 for an ambulance or go to?your nearest accident and emergency (A&E) department immediately if you experience a combination of:

  • a sharp, sudden and intense pain in your tummy
  • feeling?very dizzy or fainting
  • feeling sick
  • looking very pale

These symptoms could mean that your fallopian tube has split open (ruptured). This is very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible.

A rupture can be life-threatening, but fortunately they're uncommon and treatable, if dealt with quickly. Deaths from ruptures are extremely rare in the UK.

How?an ectopic pregnancy is treated

There are three main treatments for an ectopic pregnancy:

  • expectant management - you're carefully monitored and one of the treatments below is used if the fertilised egg doesn't dissolve by itself
  • medication - an injection of a powerful medicine called methotrexate is used to stop the pregnancy?growing
  • surgery -?keyhole surgery (laparoscopy) performed under?general anaesthetic is used to remove the fertilised egg,?usually along with the affected fallopian tube

You'll be told?about the benefits and risks of each option. In many cases,?a particular treatment will be recommended based on your symptoms and the results of the tests you have.

Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant (see below). Talk to your doctor about this.

Read more about treating an ectopic pregnancy.

Help?and support after an ectopic pregnancy

Losing a pregnancy can be devastating and many women feel the same sense of grief as if they had lost a family member or partner.

It's not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.

If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your GP about this.

Support groups for people who have been affected by loss of a pregnancy can also help. These include:

Read more about?dealing with loss and find bereavement support services in your area.

Trying?for another baby

You may want to try for another baby when you and your partner feel physically and emotionally ready.

You'll probably be advised to wait until you've had at least two periods after treatment before trying again, to allow yourself to recover. If you were treated with methotrexate, it's usually recommended that you wait at least three months, because the medicine could harm your baby if you become pregnant during this time.

Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they've had a fallopian tube removed. Overall, 65% of women achieve a successful pregnancy within 18 months of an ectopic pregnancy. Occasionally, it may be necessary to use fertility treatment such as?IVF.

The chances of having another ectopic pregnancy are higher if you've had one before, but the risk is still small (around 10%).

If you do become pregnant again, it's a good idea to let your GP know as soon as possible, so early scans can be carried out to check everything's OK.

What?can cause an ectopic pregnancy?

In many cases, it's not clear why a woman has an ectopic pregnancy. Sometimes it happens when there's a problem with the fallopian tubes, such as them being narrow or blocked.

The following are all associated with an increased risk of ectopic pregnancy:

  • pelvic inflammatory disease?(PID) - inflammation of the female reproductive system, usually caused by a?sexually transmitted infection (STI)
  • previous ectopic pregnancy - the risk of having another ectopic pregnancy is around 10%
  • previous surgery on your fallopian tubes - such as an unsuccessful?female sterilisation procedure
  • fertility treatment, such as IVF - taking medication to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy
  • becoming?pregnant while using an intrauterine device (IUD) or intrauterine system (IUS) for contraception - it's rare to get pregnant while using these, but if you do you're more likely to have an ectopic pregnancy
  • smoking
  • increasing age - the risk is highest for pregnant women who are aged 35-40

You can't always prevent an ectopic pregnancy, but you can reduce your risk by using a?condom when not trying for a baby, to protect yourself from STIs, and by stopping smoking.?

Cervix
The cervix is at the lower end of the womb. It connects the womb with the vagina.
Fallopian tubes
Fallopian tubes (also called oviducts or uterine tubes) are the two tubes that connect the uterus to the ovaries in the female reproductive system.
Ovaries
Ovaries are the pair of reproductive organs that produce eggs and sex hormones in females.
Symptoms of ectopic pregnancy

Symptoms of an ectopic pregnancy?usually?develop between the 4th and 12th weeks?of pregnancy.

Some women don't have any symptoms at first. They may not find out they have an ectopic pregnancy?until an early scan shows the problem or they develop more serious symptoms later on.

Main symptoms

You may have an ectopic pregnancy if you miss a period, have a positive pregnancy test?and/or have other?signs of pregnancy, in addition to any of the symptoms listed below.

Contact your GP or call?NHS 111 if you have a combination of any of these symptoms and you think you might be pregnant - even if you haven't had a positive pregnancy test.

Vaginal bleeding

Vaginal bleeding?tends to?a bit different to your regular period. It often starts and stops, and?may be?watery and dark brown in colour.

Some women mistake this bleeding for a?regular period and don't realise they're pregnant.

Vaginal bleeding during pregnancy?is relatively common and isn't necessarily a sign of a serious problem, but you should seek medical advice?if you experience it.

Tummy pain

You may experience tummy pain, typically low down on?one side. It can develop suddenly or gradually, and may be persistent or come and go.

Tummy pain can have lots of causes, including?stomach bugs and trapped wind, so it doesn't necessarily mean you have an ectopic pregnancy. But you should get medical advice if you have?it and?think you might be pregnant.

Shoulder tip pain

Shoulder tip pain is an unusual pain felt where your shoulder ends and your arm begins.

It's not known exactly why it occurs, but it can be a sign?of an ectopic pregnancy causing some internal bleeding, so you should get medical advice right away if you experience it.

Discomfort when going to the toilet

You may?experience pain when going for a pee or poo. You may also have diarrhoea.

Some changes to your normal bladder and bowel patterns are normal during pregnancy, and these symptoms can be caused by?urinary tract infections and stomach bugs. However, it's still a good idea to seek medical advice if you experience?these symptoms?and think you might be pregnant.

Symptoms of a rupture

In a few cases, an ectopic pregnancy can grow large enough to split open the fallopian tube. This is known as a rupture.

Ruptures are very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible.

Signs of a rupture include a combination of:

  • a sharp, sudden and intense pain in your tummy
  • feeling very?dizzy or?fainting
  • feeling sick
  • looking very pale

Call 999 for an ambulance or go to?your nearest accident and emergency (A&E) department immediately if you experience these symptoms.

Causes of ectopic pregnancy

In the early stages of pregnancy, an egg is released from one of your ovaries into one of your fallopian tubes, where it is fertilised by sperm.

Each fallopian tube is about 10cm (4 inches) long and lined with millions of moving, hair-like structures called cilia. In a normal pregnancy, the cilia push the fertilised egg along the tube and into the womb, where the egg implants itself into the womb's lining (endometrium) and develops into a baby.

However, if the fallopian tube has been damaged (for example, if there is a blockage or narrowing of the tube), the cilia may not be able to move the egg to the womb, and the pregnancy may develop in the fallopian tube.

Common risk factors

Some of the most common risk factors for an ectopic pregnancy are discussed below.

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a bacterial infection of the female reproductive system. Most cases of PID are caused by an infection in the vagina or the neck of the womb (cervix) that has spread to the reproductive organs higher up.

Many different types of bacteria can cause PID, but most cases are due to a chlamydia infection - this is a type of sexually transmitted infection that can be spread during unprotected sex.

Chlamydia often exhibits no noticeable symptoms, so women may not know they are infected. However, the bacteria can cause inflammation of the fallopian tubes, which is known as salpingitis. Salpingitis leads to a four-fold increase in the risk of having an ectopic pregnancy.

Previous history

Having a previous history of ectopic pregnancy means you have an increased risk of having one in the future.

Depending on the underlying factors, the risk of having another ectopic pregnancy is somewhere between 1 in 10 and 1 in 4.

Previous surgery

If you have ever had surgery that involved your fallopian tubes, you have an increased risk of having an ectopic pregnancy. Types of surgery known to increase your risk include:

  • female sterilisation (a type of surgery known as tubal ligation or "tying the tubes") - in around 1 in 200 cases surgery fails, the woman becomes pregnant and can result in an ectopic pregnancy
  • earlier surgery to remove a previous ectopic pregnancy

Fertility treatments

Taking medication to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy by around four-fold.

The type of fertility treatment known as in-vitro fertilisation (IVF) is not always successful and can accidentally result in an ectopic pregnancy.

This occurs in around 1 in 22 cases of IVF.

Contraception

The intrauterine device (IUD) and the intrauterine system (IUS) are very effective in preventing pregnancy - the success rate is estimated to be around 99 out of 100 cases. But if a pregnancy does occur when using these types of contraception, it is more likely to be an ectopic pregnancy than a normal pregnancy.

There is also a risk that if you take emergency contraception and it fails to work, any subsequent pregnancy could be an ectopic pregnancy.

Other risk factors

Other potential risk factors for an ectopic pregnancy include:

  • structural problems - ectopic pregnancy is more likely if you have an abnormally shaped fallopian tube
  • smoking - smokers are twice as likely to have an ectopic pregnancy than non-smokers
  • being aged over 35
Diagnosing ectopic pregnancy

It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions.

Your GP may examine you and offer a pregnancy test. If you have the symptoms of an ectopic pregnancy and a positive pregnancy test, you may be referred to an early pregnancy assessment service for further testing.

Some of the tests you may have are outlined below.

Vaginal ultrasound

An ectopic pregnancy is usually diagnosed by carrying out a transvaginal ultrasound scan.

This involves inserting a small probe?into your vagina. The probe is so small that it is easy to insert and you won't need a local anaesthetic. The probe emits sound waves that bounce back to create a close-up image of your reproductive system on a monitor.

This will often show whether a fertilised egg has become implanted in one of your fallopian tubes, although occasionally it may be very difficult to spot.

Blood tests

Blood tests?to measure the pregnancy hormone human chorionic gonadotropin (hCG) may also be carried out twice,?48 hours apart,?to see how the level changes over time.

This can be a?useful way of identifying ectopic pregnancies that aren't found during an ultrasound scan, as the level of hCG tends to be lower and rise more slowly over time than in a normal pregnancy.

The results of the?test can also be useful in determining the best treatment for an ectopic pregnancy. Read more about how an ectopic pregnancy is treated.

Keyhole surgery

If it's still not clear whether you have an ectopic pregnancy, or the location of the pregnancy is unknown, a laparoscopy may be carried out.

This is a type of keyhole surgery carried out under?general anaesthetic (where you're asleep) that involves making a small cut (incision) in your tummy and inserting a viewing tube called?a laparoscope.

Your doctor uses the laparoscope to examine the?womb and fallopian tubes directly.

If an ectopic pregnancy is found during the procedure, small surgical instruments may be used to remove it, to avoid the possible need for a second operation later on.

Read more about surgery for an ectopic pregnancy.

Scan
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Treating ectopic pregnancy

Unfortunately, the baby cannot be saved in an ectopic pregnancy. Treatment is?usually needed to remove the pregnancy before it grows too large.?

The main treatment options are:

  • expectant management?-?your condition is carefully monitored to see whether treatment is necessary
  • medication?- a medicine called methotrexate is used to stop the pregnancy growing?
  • surgery?- surgery is used to remove the pregnancy,?usually along with the affected fallopian tube

These options each have advantages and disadvantages that your doctor will discuss with you.

They'll recommend what they think is the most suitable option for you, depending on factors such as your symptoms, the size of the pregnancy and the level of pregnancy hormone (human?chorionic gonadotropin or hCG) in your blood.

Expectant management

If?you have no symptoms or mild symptoms and the pregnancy is very small or can't be found, you may only need to be closely monitored, because?there's a good chance the pregnancy will dissolve by itself.

This is known as expectant management and the following is likely to happen:?

  • You'll have regular blood tests to check that the level of hCG in your blood is going down?- these will be needed until the hormone is no longer found.
  • You may need one of the treatments outlined below if?your hormone level doesn't go down or it increases.
  • You'll usually have some vaginal bleeding?- use sanitary pads or towels, rather than tampons, until this clears up.
  • You may experience some tummy pain?- take?paracetamol to relieve this.
  • You'll be told what to do if you develop more severe symptoms.

The main advantage of monitoring is that you won't experience any side effects of treatment. A disadvantage is that there's still a small risk of your fallopian tubes splitting open (rupturing) and you may eventually need treatment.

Medication

If an ectopic pregnancy is diagnosed early but active monitoring isn't suitable, treatment with a medicine called methotrexate may be recommended.

This?works by stopping the pregnancy from growing and is given as a single injection into your buttocks.

You won't need to stay in hospital?after treatment, but regular blood tests will be?carried out?to check if the treatment is working. A second dose is sometimes needed and surgery (see below) may be necessary if it doesn't work.

You need to use reliable?contraception for at least three months after treatment, because methotrexate can be harmful for a baby if you become pregnant during this time.

It's also important to avoid alcohol until you're told it's safe, as drinking soon after receiving a dose of methotrexate can damage your liver.

Other side effects of?methotrexate include:

  • tummy pain?- this is usually mild and should pass within a day or two
  • dizziness
  • feeling and being sick
  • diarrhoea

There's also a chance of your fallopian tubes rupturing after treatment. You'll be told what to look out for and what?to do if you think this has happened.

Surgery

In most cases,?keyhole surgery (laparoscopy) will be carried out to remove the pregnancy before it?becomes too large.

During a laparoscopy:

  • you're given?general anaesthetic, so you're asleep while it's carried out
  • small cuts (incisions) are made in your tummy
  • a thin viewing tube (laparoscope) and small surgical instruments are inserted?through the?incisions
  • the?entire fallopian tube containing the?pregnancy is removed if your other fallopian tube looks healthy?- otherwise, removing the pregnancy without removing the whole tube may be attempted

Removing the affected fallopian tube?is the most effective treatment and isn't thought to reduce your chances of becoming pregnant again. Your doctor will discuss this with you beforehand and you'll be asked whether you consent to having?the tube removed.

Most women can leave hospital a few days after surgery, although it can take four to six weeks to?fully recover.

If your fallopian tube has already ruptured, you'll need emergency surgery. The surgeon will make a larger incision in your?tummy (laparotomy)?to stop the bleeding and repair your fallopian tube, if that is possible.

After either type of surgery,?a treatment called?anti-D rhesus prophylaxis will be given?if your blood type is RhD negative (see?blood groups for more information). This involves an injection of a medicine that helps to prevent rhesus disease in future pregnancies.

 
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