A B C D E F G H I J K L M N O P R S T U V W

ECTOPIC PREGNANCY

What is an Ectopic Pregnancy ?

Ectopic means out of place. When pregnancy occurs outside the womb it is ectopic. The commonest site for an ectopic pregnancy is in the Fallopian tube (oviduct). There are two tubes about 10cm long. Each is shaped rather like a trumpet and the narrow end enters the top of the womb. The sperm swims up from the vagina, through the womb and out into the tube. Here it fertilizes the egg. The fertilized egg now has to make its way down the tube to the womb where it will develop. The journey takes about 3 days. The tube has to provide an open passage for this to happen. It also has to provide the right secretions to feed the egg before it reaches the womb. The tube contracts and relaxes. This gently squeezes the egg along the tube into the womb. If the egg gets stuck in the tube it will try to implant there and grow. This results in an ectopic pregnancy. The first symptom is usually that the period is late and the woman feels pregnant. As the pregnancy grows in the tube she may feel pain on one side in the lower abdomen. This pain may make her feel faint and may spread across the abdomen. She may feel an odd pain in her shoulder. She may has some bleeding from the vagina. If the pregnancy bursts the tube it will cause bleeding inside the abdomen. If this happens there will be a lot of pain in the abdomen and the woman may collapse. Sometimes the early symptoms of an ectopic pregnancy may be difficult to tell apart from the symptoms of a miscarriage. In this case the ectopic pregnancy may be suspected when an ultrasound scan is carried out. In the early stages there may be no symptoms with an ectopic pregnancy.

How does an Ectopic Pregnancy occur ?

It is a narrowing or distortion of the tube which usually causes the egg to stick. Sometimes the tubes are healthy. In these cases, it may be that the egg has grown too quickly.

Why does an Ectopic Pregnancy occur ?

Usually the tube has been damaged by infections or previous surgery. The infection may be sexually transmitted (gonorrhoea or chlamydia) or may follow a termination or even appendicitis. Previous operations on ovarian cysts or on the tubes for infertility increase the risk of ectopic pregnancy . There is a greater risk of ectopic pregnancy on the rare occasions when the woman conceives after sterilization or after an operation to reverse sterilization. If a woman conceives while she has a contraceptive coil in place, there is an increased risk of an ectopic pregnancy. There is also a greater risk of ectopic pregnancy if a woman conceives after gamete intra-fallopian transfer (GIFT) or in vitro fertilization (IVF).

Treatment Involved for an Ectopic Pregnancy

Ectopic pregnancy is a serious condition and medical advice is urgent. MEDICAL TREATMENT In some cases it may be possible to give an injection of a drug called methotrexate. This makes the egg die and an operation may be avoided. Not all ectopic pregnancies are suitable for this sort of treatment and it is not available in all hospitals. Some patients who have this treatment will still need to have surgery. SURGICAL TREATMENT A laparoscopy is usually done to confirm the diagnosis. For laparoscopy a general anaesthetic is required, and the doctor needs to be told about any allergies or drugs being taken. A small cut is made below the navel, through which a telescope is inserted and the surgeon can see the ectopic pregnancy. An ectopic pregnancy can also be removed by laparoscopy although it may be necessary to do an abdominal operation (laparotomy) in some cases. The tube may have to be removed, although it may be possible to remove the pregnancy and save the tube. In such a case there would be a risk of further ectopic pregnancy in that tube. A blood transfusion may be given because quite a lot of blood can be lost.

During Treatment for an Ectopic Pregnancy

If you have had medical treatment or surgery where the tube has not been removed you will need to have blood tests every few days afterwards to make sure the treatment has destroyed or removed all the pregnancy tissue. The test measures the pregnancy hormone (hCG) level. If this does not fall or starts to increase it may indicate that a further injection or surgery might be necessary. Provided you are well these tests can usually be done as an outpatient. It is not uncommon to have some further pain in the first few days after medical treatment but it may be necessary to return to the hospital if this occurs as a small proportion of ectopic pregnancies may burst through the tube after medical treatment and need surgery. If a laparoscopy only is done the hospital stay will be about 48 hours. For a laparotomy it will be 3-5 days. The periods return in 4 to 6 weeks. Everything should be back to normal in 6 weeks.

After Treatment for an Ectopic Pregnancy

Women who have had one ectopic pregnancy are more likely to get another. About 1 in 10 pregnancies occuring after an ectopic pregnancy will be another ectopic but most will be in the womb as normal. If a period is missed or is unusually light a pregnancy test should be done. As soon as another pregnancy is confirmed, the doctor should be notified. A scan will be done to check that the pregnancy is in the womb. Any possible sexual infection should be treated promptly. After an ectopic pregnancy the chances of conceiving again will be less, even if a tube has not been removed. This is because the delicate lining of the tube is damaged by the ectopic and this makes it difficult for the egg to pass down the tube. If a further pregnancy is desired, this should be discussed with the surgeon. It might be wise to be followed up in a specialist fertility clinic. If both tubes are badly damaged or removed, help may come from a test-tube baby programme. An ectopic pregnancy should make no difference to your periods in the future.

If an Ectopic Pregnancy is Left Untreated

The embryo might just die and slowly disappear. More likely the pregnancy will grow and may burst through the tube causing internal bleeding with a risk of death of the patient if still nothing is done.

Effects on Family of an Ectopic Pregnancy

A woman needs love, sympathy and understanding after an ectopic pregnancy. She will have had an operation but has also lost a baby. She may be tearful and depressed for some time. She will be worried about the possibility of the same problem happening again in future pregnancies.