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What is Ectopic Pregnancy?
In a normal pregnancy, your ovary releases an egg into your fallopian tube. If the egg meets with a sperm, the fertilized egg moves into your uterus to attach to its lining and continues to grow for the next 9 months.
But in up to 1 of every 50 pregnancies, the fertilized egg stays in your fallopian tube. In that case, it’s called an ectopic pregnancy or a tubal pregnancy. In rare cases, the fertilized egg attaches to one of your ovaries, another organ in your abdomen, the cornua (or horn) of the uterus or even the cervix. In any case, instead of celebrating your pregnancy, you find your life is in danger. Ectopic pregnancies require emergency treatment.
Most often, ectopic pregnancy happens within the first few weeks of pregnancy. You might not even know you’re pregnant yet, so it can be a big shock. Doctors usually discover it by the 8th week of pregnancy.
Ectopic pregnancies can be scary and sad. The baby probably can’t survive though in extremely rare cases he or she might. (This is not possible in a tubal pregnancy, cornual or cervical ) So it’s a loss that may take some time to get over. It may comfort you to know that if you have an ectopic pregnancy, you’ll likely be able to have a healthy pregnancy in the future.
Ectopic pregnancy facts
- An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus.
- Risk factors for ectopic pregnancy include previous ectopic pregnancies and conditions (surgery, infection) that disrupt the normal anatomy of the Fallopian tubes.
- The major health risk of an ectopic pregnancy is internal bleeding.
- Diagnosis of ectopic pregnancy is usually established by blood hormone tests and pelvic ultrasound.
- Treatment options for ectopic pregnancy include both surgery and medication.
How does it happen?
After conception, the fertilized egg travels down one of your fallopian tubes on its way to your uterus. If the tube is damaged or blocked and fails to propel the egg toward your womb, the egg may become implanted in the tube and continue to develop there.
Because the vast majority of ectopic pregnancies occur in a fallopian tube, they’re often called “tubal” pregnancies. Much less often, an egg implants in an ovary, in the cervix, directly in the abdomen, or even in a c-section scar.
It’s also possible for a woman to have one embryo normally implanted in her uterus and another implanted in her tube or elsewhere. This is called a heterotopic pregnancy, and it’s pretty rare, occurring in only 1 in 4,000 pregnancies.
If an ectopic pregnancy isn’t recognized and treated, the embryo could grow until the fallopian tube ruptures, resulting in severe abdominal pain and bleeding. This can cause permanent damage to the tube or loss of the tube, and if it involves very heavy internal bleeding that’s not treated promptly, it can even lead to death. That’s why early diagnosis, treatment, and follow-up care are so important.
Causes of Ectopic pregnancy
In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include:
- Birth defect in the fallopian tubes
- Scarring after a ruptured appendix
- Having had a previous ectopic pregnancy
- Scarring from past infections or surgery of the female organs
The following also increase risk of an ectopic pregnancy:
- Age over 35
- Getting pregnant while having an intrauterine device (IUD)
- Having your tubes tied (tubal ligation): This is more likely 2 or more years after the procedure
- Having had surgery to untie tubes (tubal sterilization) to become pregnant
- Having had many sexual partners
- Some infertility treatments
The most common site for an ectopic pregnancy is within one of the two fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix.
What Are the Symptoms of Ectopic Pregnancy?
Very early in pregnancy, ectopic pregnancies seem like normal pregnancies. A woman may have a missed period, breast tenderness, fatigue, and nausea.
Symptoms of ectopic pregnancy include
- severe abdominal pain on one side of the body
- cramps and spotting
- vaginal bleeding
- shoulder pain
- nausea and vomiting
- fainting spells or dizziness
If you have severe pain or bleeding, go to the emergency room right away. If you have any other symptoms of ectopic pregnancy, contact your health care provider right away. The earlier an ectopic pregnancy is diagnosed and treated, the better.
Who gets ectopic pregnancy?
Ectopic pregnancy can occur in any sexually active woman. In the UK there are around 10,700 ectopic pregnancies each year.
The chance is higher than average in the following at-risk groups:
- If you have already had an ectopic pregnancy you have a slightly higher chance that a future pregnancy will be ectopic. If you have had two or more ectopic pregnancies, then your chances of another ectopic pregnancy are even greater.
- If you have kinking, scarring, damage, or other abnormality of a Fallopian tube. This is because a fertilised egg (ovum) may become stuck in the tube more easily. For example:
- If you have had a previous infection of the womb (uterus) or Fallopian tube (pelvic inflammatory disease). This is most commonly due to either chlamydia or gonorrhoea. These infections can lead to some scarring of the Fallopian tubes. Chlamydia and gonorrhoea are common causes of pelvic infection.
- Previous sterilisation operation. Although sterilisation is a very effective method of contraception, if a pregnancy does occur, about 1 in 20 is ectopic.
- Any previous surgery to a Fallopian tube or nearby structures.
- If you have a condition of the uterus and surrounding area (endometriosis).
- If you use a coil (intrauterine contraceptive device). Again, pregnancy is rare as this is a very effective method of contraception.
- If you are using assisted conception (some types of infertility treatments).
- The risk of ectopic pregnancy increases in women over the age of 35 years and also in smokers.
However, around one third of women with an ectopic pregnancy do not have any of these risk factors.
How is an ectopic pregnancy treated?
If an ectopic pregnancy is detected at an early stage, a medication called methotrexate is sometimes needed to stop the egg developing. The pregnancy tissue is then absorbed into the woman’s body.
However, methotrexate is not always needed in around half of cases, the egg dies before it can grow.
Ectopic pregnancies detected at a more advanced stage will require surgery to remove the egg.
If an ectopic pregnancy is left to develop, there is a risk that the fertilised egg could continue to grow and cause the fallopian tube to split open (rupture), which can cause life-threatening internal bleeding.
Signs of a ruptured fallopian tube are:
- sudden, severe, sharp pain
- feeling faint and dizzy
- feeling or being sick
- shoulder tip pain
A ruptured fallopian tube is a medical emergency. If you think that you or someone in your care has experienced this complication, call 999 and ask for an ambulance.