6 things to know about ectopic pregnancy

Approximately 1 in every 100 pregnancies is ectopic. Although in recent years many ectopic pregnancies have been treated without surgery, if you suspect you have an ectopic pregnancy, you should seek medical attention immediately.

Symptoms include lower abdominal pain, which can become quite uncomfortable. The ruptures that an ectopic pregnancy can cause are very dangerous and life-threatening for the pregnant woman. In such a situation, an emergency operation is needed. In an ectopic pregnancy, the fetus develops outside the uterus.

1. How does an ectopic pregnancy develop?

In most cases, an ectopic pregnancy develops when the fertilized egg attaches itself to the inner lining of the fallopian tube. In rarer cases, an ectopic pregnancy can develop in the ovaries or inside the abdomen.

2. What complications can occur with an ectopic pregnancy?

In an ectopic pregnancy, the fetus in a very large number of cases does not survive. The fetus dies after only a few days, and the mother-to-be very often does not even realize that she was pregnant.

Sometimes mild pain and vaginal bleeding like a miscarriage may occur. If this happens, in most cases nothing further needs to be done.

In other cases, the pregnancy can develop and cause the fallopian tubes to stretch, which will lead to pain and diagnosis.

The ability of the fallopian tubes to stretch is negligible, so such a pregnancy could lead to rupture and rupture of the tubes, which is accompanied by severe internal bleeding and pain. This is an emergency that requires immediate medical attention.

3. What are the symptoms of ectopic pregnancy?

Symptoms usually appear around the 6th week of pregnancy. For people with regular periods, this is about 2 weeks after the first missed period.

However, symptoms can develop any time between 4 and 10 weeks of pregnancy. It is possible that the woman may not even realize she is pregnant at this point.

Such a miss could happen if you’re using contraception that hasn’t worked, or if you don’t have a regular cycle in general. In such a case, it is possible to confuse the symptoms with a late period.

Symptoms are as follows:

– Pain on one side of the abdomen, which may appear suddenly or progressively intensify over several days.
– Vaginal bleeding is possible, but not necessarily. Bleeding may be heavier or lighter than a normal period.

Usually the blood is darker which may make you think it is a late period.

– Diarrhea and pain when passing stools may occur. A feeling of weakness may appear.

– Shoulder pain may occur. This may be the result of blood leaking into the abdominal cavity irritating the diaphragm (the muscle that helps us breathe).

– If the fallopian tubes rupture, the case is urgent, and the pain is very strong and most often with profuse bleeding.

– In some cases, there are no warning symptoms before the rupture, and it is possible to experience a sharp and severe pain.

4. Who develops an ectopic pregnancy?

Ectopic pregnancy can occur in any woman. There are around 10,700 cases of ectopic pregnancy in the UK each year.

The probability is greater in the presence of the following risk factors:

– If you have had an ectopic pregnancy, the chance is slightly higher compared to other women. If it has happened to you more than once, then the probability of a similar case in the future increases sharply.

– If you have any abnormality or twisting of the fallopian tube. This will help the fertilized egg to insert there more easily. This can happen, for example, if you have had a previous infection of the uterus or fallopian tubes (pelvic inflammatory disease).

This can be due to chlamydia or gonorrhea. These infections can lead to abnormalities in the anatomical structure of the fallopian tubes. Another case in which an ectopic pregnancy can happen to you is if you have undergone sterilization.

Although this is a very effective method of contraception, pregnancy is not completely excluded. And if this happens, the probability is 1:20 that an ectopic pregnancy will develop.

The risk is also higher in people who have had surgery on the fallopian tubes or on the organs near them. Women who have any disease of the uterus or near it are also at greater risk.

– If you use an IUD (intrauterine contraceptive device). Again, pregnancy is rare as this is a very effective method of contraception.

– The risk is greater with some types of infertility treatment.

– The risk of ectopic pregnancy increases in women over the age of 35 and also in smokers.

However, about a third of women with an ectopic pregnancy have none of these risk factors.

5. How is an ectopic pregnancy confirmed?

If you have symptoms of an ectopic pregnancy, most doctors will quickly detect them. A urine test will confirm that you are pregnant. An ultrasound scan should be done, which will give a good view of the fetus and fallopian tubes.

This will show if the person has a pregnancy problem. If the pregnancy is in a very early stage and it is not yet possible to say for sure, you could visit the office in a few days so that an ectopic pregnancy can be ruled out for sure.

Blood tests can also be done, which show changes in hormone levels.

6. What treatment methods are applicable for ectopic pregnancy?

In case of rupture of the fallopian tubes, the operation is life-saving and urgent. Its purpose is to quickly stop the bleeding.
However, an ectopic pregnancy is most often diagnosed before ruptures occur.

Your doctor will discuss the treatment options with you and in most cases you will be able to decide which treatment is best for you.

Therapeutic methods may consist of the following:

– Operative treatment – removal of the tube or part of it with the ectopic pregnancy is most often performed by laparoscopic surgery. Removing the tube is usually enough if the other tube is healthy. If the other tube is not healthy, usually only part of the tube is removed (for example, if the other fallopian tube has scars from a previous infection). However, most women do not need surgery.

– Medical treatment – treatment of ectopic pregnancy is now much more common and usually avoids the need for surgery. A drug called methotrexate is often used, which is usually given into the body parenterally.

It works by killing the cells of the fetus growing in the fallopian tube. Normally, this is only recommended if the pregnancy is very early. The advantage is that the need for surgery is avoided.

The downside is that you will need close monitoring over several weeks with repeated blood tests and scans to check that the method has worked.

You will need to have a blood test every 2-3 days until the results show that everything is fine. Ultrasound examinations are usually repeated every week.

Methotrexate can cause side effects that include nausea and vomiting in some women. It is normal to experience abdominal pain 3-7 days after taking the drug.

– The method of active surveillance – not every ectopic pregnancy is life-threatening or will pose a risk to the mother. In many cases, the condition resolves on its own without creating a risk of complications in the future.

Pregnancy often terminates in a manner similar to miscarriage. One option is to see how things go if you have mild or no symptoms.

You will need to be closely monitored by your gynecologist through repeated blood tests and other tests to monitor whether the body is able to cope with the fetus on its own.

All that has been said so far is a brief description of treatment options. And your gynecologist will have the last word, who will advise you on the pros and cons of each treatment.

One of the most common questions is – “What is the chance of a future normal pregnancy after an ectopic pregnancy?” Even if one fallopian tube is removed, you have a 7/10 chance of a normal future pregnancy. In most cases, the other fallopian tube is still usually functional.

1 in 10 future pregnancies, however, may lead to another ectopic pregnancy. Therefore, it is important that if you have had an ectopic pregnancy in the past, you go to your doctor at the beginning of each future pregnancy.

It is definitely normal to feel anxious or depressed for a while after treatment. Concerns about a possible future ectopic pregnancy, about the effect on fertility and sadness over the loss of the fetus are normal reactions.

We advise you to consult your doctor about these and any other problems, fears and concerns after the forced termination of the ectopic pregnancy.