Ectopic pregnancy

February 2017

An ectopic pregnancy is caused by the development of the egg outside the womb.
An ectopic pregnancy is an emergency situation which can put a woman's life in danger. There is a risk of internal bleeding which can sometimes be severe.
Approximately 50% of the time the pregnancy dies after a few days and you may not even know you were pregnant. However, sometimes the egg gradually continues to grow and if it has rooted in the fallopian tube for example, the tube is too small to sustain a pregnancy and it ruptures and splits which can cause internal bleeding.

The location of an ectopic pregnancy


  • If the egg has rooted in the fallopian tube: it is a tubal pregnancy.
  • If the egg is implanted in the ovary: it is an ovarian pregnancy.
  • If the egg is implanted in the cervix: it is a cervical pregnancy.
  • If the egg is implanted in the abdominal cavity: it is an abdominal pregnancy.
  • If the egg is implanted in the muscular wall of the uterus, it is an intramural pregnancy


There are very few locations, such as the liver ...

The diagnosis of ectopic pregnancy


The diagnosis is made in early pregnancy, commonly between four and eight weeks, usually two weeks after a missed period, assuming you have regular periods.

Symptoms of Ectopic Pregnancy

  • Vaginal bleeding can occur and can be heavier or lighter than a normal period. Seek medical advice if any bleeding in pregnancy occurs.
  • The onset of pain in the lower abdomen usually on one side is an important sign. It can develop gradually or suddenly and become severe,
  • Shoulder tip pain can also present as a symptom - this is caused as blood leaks into the abdomen irritating diaphragm.
  • Dizziness and sometimes collapse


The onset of severe pain on one side of the abdomen accompanied by bleeding requires an emergency medical attention.


Making a diagnosis

  • An abdominal and pelvic exam is painful
  • An ultrasound scan can allow good views of the fallopian tubes and uterus and will confirm the location of the pregnancy. However, ultrasound does not detect a very early pregnancy at 5 weeks.
  • A blood test which can measure human chorionic gonadotropin, or HCG, the specific hormone of pregnancy.
  • Monitoring the levels of HCG in the blood , a hormone which increases regularly in early pregnancy. Two successive tests are taken at 48-hour intervals, and a low rise in levels usually indicates an ectopic or non-viable pregnancy.
  • A laparoscopy allows direct visualisation of an ectopic pregnancy.

Risk Factors for ectopic pregnancy


Some women are more at risk than others of suffering with an ectopic pregnancy. Having an awareness can help identify those more at risk so that they can consult a doctor as soon as possible.
  • Tobacco
  • Use of IUD (Coils)
  • Mini pill (progesterone only)
  • Women over 35years or increase in maternal age.
  • Women who, for example, have a history of
    • Ectopic pregnancy
    • Pelvic Inflammatory disease
    • Genital infection
    • Sexually Transmitted Diseases
    • Previous surgery in the fallopian tubes or abdominal surgery.
    • Infertility problems
    • Those women receiving IVF treatment
    • One or more abortions.

Treatment of ectopic pregnancy

Medical treatment

  • Medical treatment can be used when the ectopic pregnancy is diagnosed soon enough, in early pregnancy.
  • A product is injected to stop the development of the egg.
  • The HCG assay is performed until it becomes negative
  • A second injection is sometimes necessary.

Surgical treatment is considered when the pregnancy is more advanced or when there is a risk of internal bleeding

  • A laparoscopy ('key hole' surgery)is carried out.
    • If the tube in question is not damaged, it is surgically opened and the embryo vacuum aspirated.
    • If the tube is damaged and broken, it is removed.
    • A HCG test is carried out after the intervention.
    • Laparotomy, is an operation to open up the abdomen. It is done when internal bleeding is accompanied by clinical signs which could be potentially life threatening.

Getting pregnant after an ectopic pregnancy


Your doctor will discuss with you the likely causes of the ectopic pregnancy and ensure all risk factors are minimized for next time. As a result getting pregnant after having had an ectopic pregnancy should not be impossible.

For more information and support
http://www.ectopic.org.uk/
http://www.womens-health.co.uk/ectopic.asp]
http://www.nhs.uk/conditions/Ectopic-pregnancy/Pages/Introduction.aspx]

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