What is it?
Ectopic pregnancy refers to any pregnancy outside the womb. The vast majority (95%) happen in the Fallopian tubes, but very rarely, an ectopic can arise entirely outside the reproductive system in the abdominal cavity.
Who is at risk?
Any woman can have an ectopic pregnancy. However, it is estimated that about half of all ectopic pregnancies occur as a result of damaged Fallopian tubes due to pelvic inflammatory disease (PID).
Most cases of PID are the result of sexually transmitted infections, the most common infections being chlamydia and gonorrhoea.
Other situations that increase the risk of ectopic pregnancy include:
- Endometriosis
- Previous pelvic surgery, such as tubal surgery, Caesarean section or appendectomy
- Presence of an IUD (coil) in the womb
- Taking the mini-pill (progesterone-only pill)
- Taking Emergency Hormonal Contraception (morning-after pill)
- Afro-Caribbean ancestry
Why is it dangerous?
Ectopic pregnancy is a life-threatening condition. There are still a small number of deaths in the UK every year due to ectopic pregnancy. If undiagnosed, it can lead to rupture of the tube and severe haemorrhage.
What are the symptoms?
Missed period - 80% of women will have experienced a missed period and so will suspect that they are pregnant. In the minority of women who don't miss their first period whilst pregnant, the condition is not so easily diagnosed.
Abdominal pain - This usually starts around five to seven weeks into the pregnancy ie five to seven weeks after the last period. The pain is due to distension of the tube as the embryo enlarges. The pain can be persistent and severe. It may be central, or just on one side, but not necessarily on the side of the ectopic
Shoulder-tip pain - If the tube starts to rupture, blood will leak into the abdomen. Irritation of the underside of the diaphragm leads to shoulder-tip pain
Vaginal bleeding - This occurs in 75% of cases, and typically starts after the abdominal pain.
Bladder or bowel irritation
Sickness, light-headedness, faintness and possibly collapse
How can it be treated?
If the problem is diagnosed in the very early stages of pregnancy, then it is possible to treat the condition medically with a drug called Methotrexate. This destroys the cells that form the placenta. Once these are destroyed, the mother re-absorbs the whole pregnancy sac. The majority of ectopic pregnancies are not diagnosed early enough to use this treatment. The more common treatment is removal of the fallopian tube that contains the ectopic pregnancy.
Can it happen again?
Women who have had a tube removed as a result of ectopic pregnancy may have reduced fertility thereafter, but overall, 60% of women will conceive again within 18 months of an ectopic. Those who do conceive have an increased risk of a second ectopic pregnancy (one in 10, compared to the normal risk of one in 100).
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