Ectopic Pregnancy

An ectopic pregnancy is a pregnancy that grows outside of the womb, usually in the fallopian tubes. In the UK this affects just over 1% (1 in 90) pregnancies. An ectopic pregnancy cannot survive and it may cause the tube to rupture (burst) which can cause heavy bleeding and be life-threatening to the mother.

Common symptoms of ectopic pregnancy include:

• Pain in your abdomen or pelvis
• Vaginal bleeding
• Dizziness
• Fainting
• Shoulder tip pain
• Breast tenderness
• Stomach upset (diarrhoea or pain opening your bowels)

However, some women do not have these symptoms so it is important for health professionals to consider an ectopic pregnancy in any woman who is unwell and could be pregnant. It is also a reason why it is important for you to always tell a health professional looking after you that you are pregnant.

Rarely a woman may become very unwell and collapse before an ectopic pregnancy is diagnosed. If you begin to feel very unwell in early pregnancy, this is a medical emergency and you (or whoever is with you) should call 999.

If you have pain at any time in early pregnancy or have vaginal bleeding after six weeks of pregnancy (or if you are unsure how many weeks pregnant you are) you should be referred to an Early Pregnancy Assessment Unit (or out-or-hours gynaecology service) for a transvaginal ultrasound scan.

If an ultrasound scan does not show a pregnancy inside of your womb, the health professional will need to make sure you do not have an ectopic pregnancy. Sometimes an ectopic pregnancy can be seen on the scan. Other times, the health professional will be unable to see a pregnancy on the scan, either inside or outside of the womb, called a pregnancy of an unknown location (PUL). This may mean you have an ectopic pregnancy but can also mean you either have a very early healthy pregnancy in the womb or have miscarried a very early pregnancy.

If you have a PUL the healthcare professional may recommend a treatment plan based on your symptoms and they should advise you to contact them immediately if your symptoms change, especially if they get worse. Most women will be offered two blood tests to check the levels of the pregnancy hormone hCG (the same hormone which urine pregnancy tests check for). The change in hCG levels measured 48 hours apart can guide health professionals as to how likely it is that you have a pregnancy in the womb or an ectopic pregnancy. This will help them recommend the best treatment plan for you.

If at any time you feel unwell or your symptoms change you should contact the early pregnancy assessment service (or out-of-hours gynaecology service) for advice. If you feel extremely unwell or collapse you (or the person with you) should call 999.

Treatment for ectopic pregnancy

The treatment options for ectopic pregnancy include medical treatment with methotrexate or surgery. Some units may recommend no treatment if your pregnancy hormone (hCG) levels are very low.

Methotrexate is given as an injection and works by preventing the pregnancy from growing further. Some women who choose methotrexate need to have a second injection. Some women will go on to have surgery if the methotrexate does not work. Occasionally an ectopic pregnancy may rupture after methotrexate treatment. This would cause pain, bleeding, or collapse and is an emergency. Common side effects of methotrexate are: mild abdominal pain, vaginal bleeding, nausea and vomiting, indigestion, fatigue, and dizziness. If you have any side effects or any new symptoms you are worried about you should speak to a health professional.

Surgery for an ectopic pregnancy is usually a laparoscopic (keyhole) procedure. You may be advised to have a laparoscopic salpingectomy (removal of a fallopian tube containing an ectopic pregnancy) or a laparoscopic salpingotomy (removal of just the ectopic pregnancy from the fallopian tube). In an emergency (if your fallopian tube has ruptured) you may need to have an open salpingectomy which is carried out through a scar along your bikini line (similar to a caesarean section scar). This is because the surgeon may be able to stop you bleeding more quickly. Occasionally the surgeon may not be able to perform a keyhole procedure. For example, if you have significant scarring from previous surgery.

The RCOG advises that the serious risks from a laparoscopic salpingectomy or salpingotomy affect 2 in 1000 women and include:

• Damage to bladder, bowel, womb, or major blood vessels requiring immediate repair or another operation.
• Being unable to perform a keyhole procedure
• Death is very rare (3-8 per 100000 women having a laparoscopy)

And that frequent risks include:

• Not finding the cause of your symptoms (no ectopic pregnancy seen)
• Bruising
• Shoulder-tip pain
• Wound gaping
• Wound infection
• Hernia at site where keyhole instruments were inserted.
• Persistent pregnancy tissue (trophoblast) when salpingotomy performed needing further treatment (one in five women)

The treatment you will be offered will depend on whether: you are able to return for follow-up; you have significant pain; the size of an ectopic pregnancy measure on ultrasound scan; whether the baby has a heartbeat; and the hCG level. Methotrexate is only suitable if you are able to return for follow-up and the risk of rupture is believed to be low: if you have no significant pain; a small ectopic pregnancy with no heartbeat; and an hCG level of less than 5000IU/ litre. You will be offered a salpingectomy rather than a salpingotomy unless you have risk factors for infertility, for example, if the surgeon believes your other tube may be damaged. If you have a salpingotomy you may be advised to have blood tests to check your hCG level goes back to negative. This is to identify women who have tissue left behind. If you have a salpingectomy you may be asked to take a home urine pregnancy tests after three weeks. If this is negative this confirms treatment is complete. If this is positive you need to contact the early pregnancy assessment unit to arrange further investigations and treatment. If you have surgical management of an ectopic pregnancy and are rhesus negative you will be offered an injection of anti-D.

Important Note:

All information on this website and advice and support offered by the charity team is on a non-medical basis. The charity advises that anyone going through baby loss, medical treatment or health issues, should seek advice from their own GP, Consultant, Midwife or Healthcare Professional.