Baby Care

An ectopic pregnancy occurs when the fertilized egg doesn’t progress along the fallopian tube to the uterus to implant there (ectopic actually means ‘out of place’). In an ectopic pregnancy, the egg implants outside the uterus – usually in the fallopian tube (around 95 percent of ectopics implant in the fallopian tube, although ectopic pregnancies also can occur in the ovary, cervix, or abdominal cavity) and develops there.

Ectopic pregnancy is rare but if it occurs it can be fatal because the fallopian tube is unable to stretch to accommodate the developing baby and may eventually rupture, causing heavy bleeding. Thankfully, very few ectopic pregnancies progress this far nowadays and very few result in death, due to modern antenatal screening tests.

What causes an ectopic pregnancy?
You’re at higher risk of an ectopic pregnancy if you’re an older mum, if you’ve already had a previous ectopic pregnancy, or if you smoke. Taking drugs to stimulate ovulation also raises your risk, as does becoming pregnant while taking contraceptives or with an IUD in situ. You’re also more susceptible if you have a fallopian tube abnormality, or have had prior surgery, such as a caesarean.

An infection or inflammation of the fallopian tube also can lead to an ectopic pregnancy if the tube becomes partially or completely blocked as a result. Pelvic inflammatory disease, which can be caused by sexually transmitted infections such as chlamydia or gonorrhea, is a common cause of blockages, along with endometriosis (a condition where cells from the lining of the uterus grown elsewhere in the abdominal cavity).

What are the signs of ectopic pregnancy?
One of the reasons ectopic pregnancy is so hard to diagnose is that the symptoms mimic those of a normal pregnancy. With an ectopic pregnancy you’ll still miss a period, may feel more tired than usual, you may feel sick, and your breasts may tingle and feel tender to the touch.

Things will appear to be normal at first but usually before week 10 of your pregnancy you’ll start to notice pain (that can become severe and chronic) on one side of your abdomen, and pain when you go to the toilet. You’ll also bleed – the bleeding is usually either lighter or darer than your normal period, and may also be more watery. At this point it’s common for women with an ectopic pregnancy to assume they are having their period and weren’t actually pregnant at all, or to think they must be having an early miscarriage.

The real giveaway sign that you have an ectopic pregnancy is pain in your shoulder, which occurs if the fallopian tube ruptures and causes internal bleeding. The blood irritates a specific nerve that causes referred pain in the shoulder. You’ll also feel lightheaded and dizzy, and look very pale, due to loss of blood.

Ectopic pregnancy can be diagnosed via blood tests – your levels of the pregnancy hormone human chorionic gonadotropin (hCG) will be lower than normal if you have an ectopic pregnancy – or, depending on how far along you are, with a transvaginal ultrasound. Your doctor may also carefully insert a needle into the space at the very top of your vagina, behind the uterus and in front of the rectum, since the presence of blood in this area can indicate bleeding from a ruptured fallopian tube.

If you aren’t very far along, these test results may be inconclusive and it’s possible your doctor might adopt a wait-and-see approach under close medical supervision, measuring your hCG levels every day or so (in a normal pregnancy hCG levels double every two days). However, more than half of all women who experience an ectopic pregnancy have no symptoms until they collapse due to fallopian tube rupture and internal bleeding.

Treating ectopic pregnancy
Unfortunately, ectopic pregnancies aren’t viable so if yours is discovered before serious complications arise your doctor may suggest surgical removal of the embryo using keyhole surgery techniques. If your fallopian tube is damaged beyond repair you may be advised to have it removed too, since any scarring could result in another ectopic pregnancy if you get pregnant again. Alternatively, if the pregnancy is detected early enough, you may be able to have a special injection of methotrexate to halt any further embryonic development and dissolve existing cells.

Getting pregnant again after ectopic pregnancy
Some women who have had an ectopic pregnancy have difficulty getting pregnant again, though his is more likely if they were already having fertility problems. Unfortunately the fact you’ve had an ectopic pregnancy does raise your risk of having another by about 15 percent.

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