Ectopic pregnancy
Ectopic pregnancy
An ectopic pregnancy happens when a fertilised egg implants in the wrong place. An ectopic pregnancy is almost always unable to survive. Cases where an ectopic pregnancy survives have been reported, but they are exceptionally rare.
About 1 in 80 pregnancies are ectopic. Like any pregnancy loss, an ectopic pregnancy can be deeply upsetting. You may need some time to recover emotionally as well as physically.
How an ectopic pregnancy happens
After an egg is released by the ovary, it travels along a fallopian tube. There, it can meet a sperm and become fertilised.
After fertilisation, it should continue along the fallopian tube into the uterus (womb). Usually, a fertilised egg will then implant in the uterus and start to develop.
In an ectopic pregnancy, the fertilised egg either does not reach or does not stop in the uterus. Instead, it implants somewhere it cannot fully develop.
In most ectopic pregnancies, the fertilised egg implants in one of the fallopian tubes. Less commonly, it implants in the ovary, cervix, or abdomen. It can also implant in a caesarean scar, or other places within the womb wall.
Ectopic pregnancy can be life threatening. Even though it is in the wrong place, the egg will still try to develop and get bigger. As it gets bigger, an ectopic pregnancy can rupture (burst), causing damage and internal bleeding. If this happens, a person can lose a lot of blood into their abdomen (tummy) before starting to experience symptoms.
Common Symptoms
Emergency Warning Signs
Phone 999 or go to A&E if you may be pregnant and:
- have new severe pain in your abdomen (tummy)
- have new severe pain in the tip of your shoulder that gets worse when lying down and does not ease with painkillers
- feel dizzy
- have fainted or collapsed
Get medical help if you may be pregnant and:
- have pain in your lower abdomen that can start quickly or gradually, and can be widespread or on one side only
- have vaginal bleeding
- have an upset stomach and diarrhoea
- have pain when you pass stool
- have a urinary tract infection
- have pain when you pee
Contact your GP or your local early pregnancy service.
⚠️ This symptom list is for educational purposes. Having these symptoms does not mean you have this condition. See a doctor for proper diagnosis.
Medicines Commonly Used
⚠️ These medicines are commonly used for confirmed diagnoses of this condition. This is NOT a recommendation or prescription. Treatment must be determined by your doctor.
No medicines have been linked to this condition yet.
When to See a Doctor
Phone 999 or go to A&E if you may be pregnant and:
- have new severe pain in your abdomen (tummy)
- have new severe pain in the tip of your shoulder that gets worse when lying down and does not ease with painkillers
- feel dizzy
- have fainted or collapsed
Get medical help if you may be pregnant and:
- have pain in your lower abdomen that can start quickly or gradually, and can be widespread or on one side only
- have vaginal bleeding
- have an upset stomach and diarrhoea
- have pain when you pass stool
- have a urinary tract infection
- have pain when you pee
Contact your GP or your local early pregnancy service.
Diagnosis
If it's an emergency, doctors will diagnose an ectopic pregnancy quickly, and treatment will start right away.
If your symptoms are mild, it can take a bit longer to confirm. Your doctor, nurse or midwife will run some tests to check whether your pregnancy is ectopic. These may include:
- a pregnancy test, if you have not already had one
- a physical examination of your abdomen (tummy)
- a transvaginal ultrasound scan, where a thin ultrasound probe is placed inside your vagina to look at your womb from within
Most ectopic pregnancies are found through a transvaginal ultrasound scan. However, it is quite common for the first scan not to show exactly where the pregnancy is. This is called a pregnancy of unknown location (PUL). It can mean one of a few things:
- your pregnancy is not in the right place, but has not been located yet
- your pregnancy is in the right place, but is still too small to see on the scan
- you have had an early miscarriage
You will usually be offered blood tests to track changes in your pregnancy hormones, and you may be asked to come back for more ultrasound scans. In most of these cases, you will get a diagnosis within about 4 days. In rarer cases, it can take a few weeks of follow up before things become clear.
Treatment
The treatment you are offered will depend on a few things, including how many weeks pregnant you are, your symptoms, and your test results. Your doctor, nurse or midwife will talk through your options with you and explain what each one could mean for your health and your future fertility, that is, your ability to get pregnant again. They will work with you to plan the treatment that suits you best.
If your fallopian tube has ruptured, you will be offered emergency surgery straight away. This is because a rupture carries a high risk of severe internal bleeding, which can be life threatening. There is no other way to treat a ruptured fallopian tube.
For ectopic pregnancies that are not an emergency, there are 3 possible treatments. Depending on your situation, you may be offered expectant management, medical treatment, or surgical treatment.
Expectant management
This approach means waiting to see if the ectopic pregnancy ends on its own. Your doctor, nurse or midwife will check your hormone levels to judge whether this is a safe path for you, and they will keep monitoring those levels to make sure it stays safe as time goes on.
If the pregnancy does end by itself, you will likely have some bleeding. During this time, use external period products such as pads rather than internal ones such as tampons, as this lowers the risk of infection.
If expectant management does not work, you will be offered one of the other options.
Medical treatment
In some cases, an ectopic pregnancy can be treated with medicine rather than surgery. You will be given an injection of a drug called methotrexate, which stops the pregnancy from growing further.
Most people only need 1 injection of methotrexate, though 15% of those who receive it will need a second dose.
There is still a chance you may need surgery later if this treatment does not fully work. This is more likely if your pregnancy is further along or if your pregnancy hormone levels are high.
After the injection, you may need to visit the clinic or ward again for follow up blood tests, which confirm that the pregnancy has ended. If you have any bleeding once the pregnancy has ended, use external period products like pads rather than internal ones like tampons, to help reduce the risk of infection.
If the medicine works as intended, you will not need surgery at all.
Surgical treatment
An ectopic pregnancy needing emergency care will always be treated with surgery. Surgery is also offered as a planned option in non-emergency cases.
There are 2 types of surgery for ectopic pregnancy, and both remove the ectopic pregnancy. Wherever possible, surgeons prefer keyhole surgery, also known as laparoscopy. In this method, the surgeon works through a tiny camera inserted into the body, which means only a small cut is needed in the abdomen.
In some situations, such as when there is internal bleeding, a larger cut may be necessary. This is called open surgery, or laparotomy.
The type of operation offered to you will depend on how urgent your surgery is, the extent of damage the ectopic pregnancy may have caused, and your own plans for future pregnancies. Sometimes a surgery that starts as keyhole surgery has to be changed to open surgery partway through, for various reasons.
If the ectopic pregnancy is in your fallopian tube, that tube is likely to be damaged, and your surgeon will usually need to remove it. Removing the damaged tube also helps lower the chance of another ectopic pregnancy happening in future.
Pregnancy after an ectopic pregnancy
Having had an ectopic pregnancy does not mean you cannot go on to have a successful pregnancy later. Even if one fallopian tube has been removed, you still have a good chance of conceiving again, since the remaining tube is able to pick up an egg released from the opposite ovary.
It is best to wait for some time before trying to conceive again. You should wait 3 to 6 months after medical treatment, following your doctor or midwife's advice, or until you have had 2 periods if you had surgical treatment. In either case, it is just as important to wait until you feel emotionally ready to try again.
As soon as you know you are pregnant again, get in touch with your local maternity service and let them know you have had an ectopic pregnancy before. They may arrange additional scans to confirm the pregnancy is developing in the right place.
Support after an ectopic pregnancy
It is natural to feel grief and loss after this experience, and you may also feel anxious about becoming pregnant again. If you feel you need more support after this loss, speak with your doctor, who can guide you toward the right kind of help and support available to you.