Ectopic pregnancy is a life threatening condition affecting 1 in 80 pregnancies. Ectopic means out of place and an ectopic pregnancy is one which implants outside of the uterus. Both the physical and emotional recovery can be a difficult experience for many women.

95% of ectopic pregnancies occur in the fallopian tube (also known as tubal pregnancies) but it is possible to have an ectopic pregnancy in the ovaries, cervix or abdomen. If not treated, the ectopic pregnancy can rupture and cause severe bleeding which may lead to collapse and maternal death.

In an ectopic pregnancy the fertilised egg gets stuck during the journey from the fallopian tube to the womb.

In the case of many ectopic pregnancies, it is not known why this happens. One of the most common reasons is damage to the tube due to conditions such as appendicitis, pelvic inflammatory disease, endometriosis or surgery in the abdominal area. In other instances there is a problem with the walls of the tube, which interrupts the normal movement or wafting of the egg from the tube into the womb. This can happen in women who use contraceptive methods such as the coil and progesterone based contraceptive medications.

Techniques such as IVF and ICSI are not risk-free. About 2-5% of clinical pregnancies are ectopic with IVF. The figure is higher for women with a history of a previous ectopic pregnancy or tubal infertility. Despite the fact that the embryo(s) is transferred directly into the uterus through the cervix, it is still possible for it to migrate to the tubes, back out in the abdomen or ovaries, or onto the cervix and implant there. If you are undergoing either IVF or IUI treatment and you do get pregnant, keep an eye out for symptoms of ectopic pregnancy.

Symptoms

Symptoms can vary, which can make diagnosis difficult - but often include abdominal pain (which can come and go, with varying severity), shoulder tip pain, vaginal bleeding (constant or on and off), pain/diarrhoea during bowel movement, nausea and feeling light headed, faint or actual collapse.

Diagnosing an ectopic pregnancy

The main methods of diagnosis are:

• The measurement of the pregnancy hormone beta hCG in the blood (in early pregnancy beta hCG approximately doubles every 48 hours)

• A vaginal ultrasound scan

• Laparoscopy (keyhole surgery)

Treatment

Unfortunately, an ectopic pregnancy cannot be saved. When diagnosis is made, the treatment options depend on the age or size of the ectopic pregnancy. If there is any risk of rupture, the pregnancy must be removed.

Monitoring clinical symptoms

In some cases the ectopic pregnancy does not progress and it may be possible to manage the pregnancy without surgery, i.e. by monitoring the hCG levels until they fall and by using ultrasound scans.

Keyhole surgery (laparoscopy)

This procedure is done under general anaesthetic to examine the inside of the abdominal cavity and to remove the ectopic pregnancy. In some cases, it might be possible to remove the ectopic leaving the tube intact but if the ectopic is large, if the tube is badly damaged or if there is significant bleeding the tube and pregnancy will be removed together.

Abdominal surgery (laparotomy)

If the ectopic pregnancy has not been diagnosed soon enough or the woman presents with severe symptoms, then she may need open abdominal surgery to remove the ectopic. In this case, it is unlikely that the tube will be saved.

Treatment with Methotrexate

Methotrexate is a drug which is given in injection form to treat ectopic pregnancy, although it is not a suitable treatment in all cases. Regular monitoring with blood tests is required until the beta hCG levels fall to non-pregnant levels.

Recovering from an ectopic pregnancy

An ectopic pregnancy can be an overwhelming and confusing experience. You have lost a pregnancy, and often you also have to deal with the physical recovery following surgery. You might be uncertain of your future fertility.

Even though having one ectopic pregnancy increases your risk of having another one to about 10%, it does not mean that you will not have any (more) children. Most women will go on to have healthy pregnancies after ectopic pregnancy but it is important that you contact your GP or Early Pregnancy Unit as soon as you are pregnant again so they can make sure the pregnancy is progressing normally.

Support and Information

For more information and support, visit Ectopic Pregnancy Ireland, where you also can read personal stories of women that have had similar experience. You are not alone!