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Ectopic pregnancy

Published by Bupa's health information team, February 2008.

This factsheet is for people who would like information about ectopic pregnancy. This is when pregnancy occurs outside the womb, for example in one of a woman's fallopian tubes. It's not possible for pregnancy to survive outside the womb and immediate treatment may be needed.

About ectopic pregnancy
Symptoms
Causes
Diagnosis
Treatment
Prevention
Further information
Questions and answers
Related topics
Sources

About ectopic pregnancy

If you have an ectopic pregnancy, it means that you have become pregnant but the fertilised egg has implanted somewhere other than in the womb. Ectopic pregnancies most commonly occur in one of the fallopian tubes, but can also happen in other places including:

the point where the fallopian tube meets the womb
on one of the ovaries
at the neck of the womb (cervix)
in the abdomen (tummy)

Illustration showing the different places where ectopic pregnancy can occur
The different places where ectopic pregnancy can occur

Ectopic pregnancy occurs in about one in every 100 pregnancies. The number of women developing ectopic pregnancies doubled between about 1970 and 1990, but since then the level has stayed quite steady. The increase is thought to be because of a rise in the number of women getting pelvic inflammatory disease. This is usually a result of the sexually transmitted infection chlamydia.

The increase in the number of ectopic pregnancies may also be partly because doctors now have more advanced ways of diagnosing the condition. In the past, women might have had an ectopic pregnancy without realising because it was never diagnosed.

Symptoms

The symptoms of ectopic pregnancy are different for all women. Some of the most common symptoms include the following.

You may have pain in your abdomen, usually just on one side. This varies between women from being quite mild to extremely severe. It may come on over a few days or suddenly without any warning.
There may be bleeding from your vagina. This may be heavier or lighter than your usual monthly period, and it may be a different colour.
You may have missed a monthly period. However, you may not have realised this if the ectopic pregnancy occurs very early, and you may have mistaken any bleeding for your period.
It's possible that you will have pain in the tip of your shoulder. If there is blood in your abdomen, this can irritate the diaphragm (the sheet of muscle that lies between your abdomen and your chest). The diaphragm shares nerves with those running to the shoulder, so pain from the diaphragm is felt at the shoulder.
If your fallopian tube ruptures (tears) as a result of being stretched by the fertilised egg growing there, you may have serious heavy bleeding and extreme pain. This may cause you to collapse or faint.
It's possible that you will also have symptoms such as diarrhoea, feeling or being sick, dizziness and light-headedness.

If you have missed a period and could be pregnant, it's important that you see your GP if you have any of these symptoms.

Causes

The main reason for ectopic pregnancy is because the fallopian tubes have been damaged, possibly as a result of previous abdominal surgery. As mentioned earlier, this may be the result of a sexually transmitted infection. In the UK, chlamydia is the most common cause of pelvic inflammatory disease. The inflammation can damage the fallopian tubes and may lead to them becoming narrowed or scarred. This means that if an egg is fertilised, it will take longer to travel down the fallopian tube to the womb and so may implant in the tube instead.

There are a number of other things that may mean you are more at risk of ectopic pregnancy, including:

if you smoke
if you have had treatment for infertility
if you have had a previous ectopic pregnancy

However, for most ectopic pregnancies, the cause is unknown and isn't associated with any of the factors mentioned here.

Diagnosis

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

If your GP thinks you may have an ectopic pregnancy, but you aren't sure if you are pregnant, he or she will ask you to do a pregnancy test. This involves testing a sample of your urine for a hormone (a chemical produced naturally by your body) called human chorionic gonadotrophin (hCG). This is released by the developing baby.

If the test is positive, you will have an ultrasound scan to see if there is a fertilised egg in your womb. An ultrasound uses sound waves to produce an image of the inside of part of your body. If the scan shows that your womb is empty, but the level of hCG is high enough that a pregnancy would normally be expected to be seen in the womb, then it's very likely that you have an ectopic pregnancy.

It's possible that your doctor may carry out a procedure called a laparoscopy to check whether or not you have an ectopic pregnancy. This is a test that allows your doctor to see inside your abdomen. The test is done using a narrow, tube-like telescopic camera called a laparoscope which is inserted through your abdomen. You will usually have a general anaesthetic - this means that you will be asleep during the operation and feel no pain.

If you collapse or have heavy bleeding, there may not be time to carry out these tests. If this happens, you will probably be taken straight to hospital for treatment.

Treatment

The treatment you have for ectopic pregnancy depends on how severe your symptoms are. This will vary according to how advanced the pregnancy is and whether or not your fallopian tube has ruptured.

Some ectopic pregnancies don't need any treatment because the pregnancy can't survive and ends by itself. If your symptoms aren't severe and your fallopian tube hasn't ruptured, it's possible that your doctor may observe your symptoms and monitor your condition. This will involve measuring your level of hCG to ensure it doesn't increase and carrying out ultrasound scans to check the progress of the pregnancy.

Your doctor may recommend that you have an injection of a medicine called methotrexate. This disrupts the pregnancy and causes it to end. You may be given the injection directly into the pregnancy or into a muscle from where it's transported in your blood to the ectopic pregnancy. This method prevents any further possible damage to your fallopian tube. You may need to have more than one dose. Although both methods are equally successful, the medicine isn't always effective at preventing the fallopian tube from rupturing and about one in 10 women will still need to have surgery.

If you need to have surgery to remove an ectopic pregnancy, your doctor may be able to do this when he or she does the laparoscopy. This is known as keyhole surgery because the cut in the wall of your abdomen is much smaller. The pregnancy is either removed by cutting into your fallopian tube and taking out the affected part or by pushing the pregnancy down to the end of the tube without cutting into it. Very occasionally your surgeon may try to repair the fallopian tube.

You may need to have an operation called a laparotomy if your fallopian tube has ruptured and your health is at risk. This is major surgery and involves making a cut through the wall of your abdomen and removing part or all of your fallopian tube. However, as keyhole surgery techniques improve, it's becoming less common for this type of surgery to be needed.

Prevention

It's not possible to prevent ectopic pregnancy as it can affect any woman. However, your risk is greatly reduced if you take measures to protect yourself against sexually transmitted infections which could damage your fallopian tubes.

If you smoke, it's a good idea to think about stopping as smoking increases your risk of ectopic pregnancy.

Further information

The Ectopic Pregnancy Trust
020 7733 2653
www.ectopic.org.uk