Ectopic Pregnancy

An ectopicpregnancyis when the embryo implants itself outside of the uterine cavity. In about 95% of ectopic pregnancies, the egg settles in the fallopian tubes, but it can also implant in the ovary, the abdomen or the cervix. Cervical ectopic pregnancies are very rare and happen in less than 1% of all pregnancies. None of these areas has as much space or nurturing tissue as a uterus for a baby to develop. Almost all ectopic pregnancies result insurgery and loss of the baby.

As the foetus grows, it will most likely rupture the organ that contains it. This can cause severe bleeding and endanger the mother's life. Around 5 pregnancies in 1,000 are ectopic.

Ectopic pregnancy symptoms

Many ectopic pregnancies go undiagnosed until it becomes a medical emergency, presenting a danger to the new mum. This most commonly occurs between the fourth and twelfth week of pregnancy. They are difficult to diagnose as they often present signs that are associated with an oncoming period (missed period) or a possible miscarriage (lower abdominal pain and vaginal bleeding).

Signs of ectopic pregnancy

• Unusual vaginal bleeding bleeding that is different from your period, in that it is either heavier or lighter than usual, with a darker colour and more watery composition.
• Pain which is on one side of the abdomen. This pain can be quite severe.
• Shoulder tip pain (see below).
• If the fallopian tube ruptures, rapid onset of severe pain in the lower abdomen and pain in the shoulder.
• Bowel pain, sometimes with diarrhoea and vomiting.

Ectopic pregnancy pain

Shoulder tip pain is felt where the shoulder ends and the arm begins. It is not known exactly why shoulder tip pain happens, but it usually occurs when lying down and is a sign that the ectopic pregnancy is causing internal bleeding. The bleeding is thought to irritate the phrenic nerve, which is found in the diaphragm (the muscle used during breathing that separates the chest cavity from the abdomen). The irritation to the phrenic nerve causes referred pain (pain that is felt elsewhere) in the shoulder blade.

Risk factors for ectopic pregnancy

In around 50% of cases, there are no known risk factors for ectopic pregnancy.

• Previous diagnosis with Chlamydia and pelvic inflammatory disease.
• Previous abdominal surgery or caesarean section.
• Fertility assisted conception.
• Conception while using an intrauterine device (IUD).
• Conception when on the mini pill (progesterone only pill).
• Endometriosis
• Increased maternal age over 35 years.
• Smoking.
• Previous ectopic pregnancy.
• Damage to the fallopian tubes due to a ruptured appendix.

Ectopic pregnancy diagnosis

To confirm the diagnosis of ectopic pregnancy, a pelvic or vaginal ultrasound with a blood test will usually be done. Laparoscopic (keyhole) surgery is often done to remove the embryo. It is important to tell your doctor if your medical history includes any known risk factors.

You should also see your doctor immediately if you experience unusual pregnancy symptoms such as cramping, pain or vaginal bleeding.

Ectopic pregnancy treatment

An ectopic pregnancy cannot normally survive as it does not receive enough blood supply and nutrition. It is either removed using a Laparoscopy (keyhole surgery) or, treated with Methotrexate, which will stop the growth of the embryo.

Future Ectopic pregnancies

Some women who have had ectopic pregnancies will have difficulty conceiving again. This is more common in women who also had fertility problems before their ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of the damage to your fallopian tubes.

The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 10% chance of having another. If one of the tubes ruptured or was badly damaged, your chances of conceiving again are reduced. There is little you can do to prevent an ectopic pregnancy from happening in the future, although if your ectopic has been caused by a current Chlamydia infection, you can have a course of antibiotics to clear it up and reduce further damage to your tubes.

Ectopic pregnancies can be very scary, but knowing the facts can help you spot a problem early on in the pregnancy before it becomes life threatening. Report any problems to your doctor right away and remember, there are effective treatments available if you do have an ectopic pregnancy.

Support

The emotional affects of having an ectopic pregnancy can be overlooked especially if the ectopic created a medical emergency. For more information and support, see your General Practitioner, midwife or health care professional. You can also visit http://cope.org.au or http://www.sands.org.au, or call the SANDS helpline on 1300 072 637.

Written for Huggies by Jane Barry Midwife and Child Health Nurse on 1/05/20.