Pregnancy – Ectopic

What is an ectopic pregnancy?
It is a pregnancy that occurs outside the uterus. This can be in one of the Fallopian tubes, on an ovary or in the abdominal cavity. The most common place is in one of the Fallopian tubes. Most ectopic pregnancies end early in pregnancy, but, occasionally, a pregnancy in the abdominal cavity will continue.

What causes ectopic pregnancy?
The most common cause is damage to the Fallopian tubes, usually caused by an infection or following abdominal surgery. There is also a slightly increased risk of ectopic pregnancy in women who have an intra-uterine contraceptive device in-situ, or who are using the progestogen-only pill and following GIFT or IVF.

What are the signs and symptoms of ectopic pregnancy?
· Late period.
· Positive pregnancy test OR a negative pregnancy test with signs of pregnancy.
· Pain on one side of the lower abdomen.

In many cases, however, early symptoms are vague or absent.

If the pregnancy continues in one of the Fallopian tubes, it will eventually grow too big for the tube, causing it to rupture. Signs of tubal rupture are:
· Dark red blood loss.
· Severe abdominal pain, possibly radiating to the shoulder tip.
· Shock.

Tubal rupture is a serious condition and it is vital that any woman with the above symptoms, whether or not she thinks she is pregnant, gets to hospital as quickly as possible, preferably by ambulance.

How is ectopic pregnancy diagnosed?
In its early stages, ectopic pregnancy can be diagnosed using an ultrasound scan. Tubal rupture, however, is a medical emergency, which would be diagnosed on clinical signs.

What is the treatment for ectopic pregnancy?
If diagnosed early, the pregnancy can be removed by laparoscopy. For this, a small cut is made just under the navel, through which a small telescope is inserted. It may be necessary to remove the Fallopian tube at the same time. Later on in pregnancy, a laparotomy or abdominal operation will be required. A laparotomy will also be required if tubal rupture is suspected.

An alternative treatment to surgery is use of the drug methotrexate. This causes the pregnancy to shrink and it will eventually disappear. However, methotrexate is not always successful and surgery may still be required.

What about future pregnancies?
Women who have had one ectopic pregnancy are at increased risk of having another one. It is essential, therefore, that an ultrasound scan is performed early in the next pregnancy to confirm that it is in the right place. Obviously, infertility will result if both Fallopian tubes have been removed and referral to a specialist fertility clinic will be needed.

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