An ectopic pregnancy is a pregnancy that develops in the wrong place, usually in a fallopian tube. Rarely, it can also be found on the ovary, a lower part of the cervix or in other parts of the abdomen. An ectopic pregnancy – which happens in about five in 1000 pregnancies – is unable to proceed normally as the fertilised egg cannot survive. The growing tissue may cause life-threatening bleeding if it is untreated.
What are the symptoms?
Symptoms of ectopic pregnancy can be likened to miscarriage or other reproductive disorders such as endometriosis or pelvic inflammatory disease. Symptoms of ectopic pregnancy usually become evident between Week 4 and Week 12 of pregnancy and can include:
- A missed period, morning sickness or breast tenderness
- Pain in the lower abdomen
- Pain in the lower back
- Cramps on the one side of the pelvis
- Vaginal bleeding or spotting
- Sudden and severe pain in the low abdomen (when the fallopian tube ruptures)
- Shoulder tip pain (where your shoulder ends and the arm begins)
- Diarrhoea and vomiting.
A ruptured fallopian tube is a medical emergency, needing immediate treatment.
Symptoms of ectopic pregnancy: Symptoms may be unnoticeable at first, though women who have an ectopic pregnancy usually have some early signs such as a missed period, tender breasts and nausea. A pregnancy test will test positive, even though an ectopic pregnancy can’t continue.
Once the fertilised egg grows in the improper place, the signs and symptoms become more noticeable. Light vaginal bleeding and pelvic pain are often the early warning signs. If blood leaks from the fallopian tube shoulder pain is common, as well as an urge to have a bowel movement. Each person’s specific symptoms depend where the blood collects and what nerves become irritated.
Emergency warning signs: If the fertilised egg continues to grow in the fallopian tube, it can cause the tube to rupture and heavy bleeding inside the abdomen is likely. This is a life-threatening event and the symptoms include being light-headed, fainting and shock. This occurs in about 15 per cent of cases and this is a medical emergency, needing immediate surgery, and in some cases, a blood transfusion. In an emergency, call triple zero (000) for an ambulance or go to your nearest hospital emergency department.
What are the causes and risk factors of ectopic pregnancy?
Ectopic pregnancy happens when a fertilised egg isn’t able to move through the fallopian tube. In many cases, it is not clear what happens. Some thoughts are that there could sometimes be a blockage in the tube or the tiny hairs inside the tube are unable to sweep the fertilised egg towards the uterus. Sometimes the fallopian tube could be damaged by inflammation or there could be hormonal imbalances. Abnormal development of a fertilised egg is also thought to play a role.
Factors that can increase a woman’s risk of ectopic pregnancy include:
- A previous ectopic pregnancy
- A successful reversal of a tubal sterilisation
- Past infection or inflammation and associated scarring
- Fallopian tube defects
- Fertility treatments
- Damage to the fallopian tubes caused by a ruptured appendix
- Falling pregnant while using a form of contraception (tubal ligation, intrauterine devices (IUD), or being on the progesterone-only pill may increase the risk of an ectopic pregnancy, though it is rare).
In about half of cases there are no obvious risk factors.
How is an ectopic pregnancy diagnosed?
In the about 15 percent of cases of ectopic pregnancy where a fallopian tube has ruptured, the diagnosis occurs in an Emergency Department. In most cases though, a range of tests may take place including a pelvic examination, blood tests or ultrasounds. This will help diagnose ectopic pregnancy, as many symptoms are similar to other conditions.
What are the treatment options?
A ruptured fallopian tube is a medical emergency, requiring laparoscopic surgery (keyhole surgery). A gynaecological surgeon will usually remove the affected tube or, in some cases, remove the pregnancy and attempt to repair the fallopian tube. Sometimes a blood transfusion is needed.
In non-emergencies, medication is often successful. Sometimes surgery might still be needed.
Is there any way to prevent an ectopic pregnancy?
It is not possible to prevent an ectopic pregnancy, though there are ways to decrease the risk.
- Early screening and pregnancy monitoring is vital, particularly if you have any known risk factors. Women at high risk are monitored closely through blood tests and ultrasound.
- Limiting sexual partners and using a condom during intercourse helps prevent sexually transmitted infection (STI), therefore reducing the risk of pelvic inflammatory disease.
- If you smoke, quit before you try to get pregnant.
- Treat any pelvic infection or STI promptly.
Where can I get support?
An ectopic pregnancy is a form of miscarriage, and this can have a huge impact on you and your partner. It is not uncommon to feel grief and bereavement. Sometimes this could last for six to 12 months or longer, although everyone is different. Many people affected by a miscarriage benefit from talking to others who have gone through a similar experience. There are counselling options available too, including:
Should I be worried about trying to fall pregnant again?
Women who have had, or do have, an ectopic pregnancy need careful monitoring. Most women who have an ectopic pregnancy go on to become pregnant again, but their pregnancy needs careful observation in the early stages, as their risk of ectopic pregnancy is higher.