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Ectopic pregnancy

ectopic; pregnancy; tubal; tubes; fallopian; ovary; ovaries;

An ectopic pregnancy is when the baby starts to develop outside the uterus (womb), most commonly in a Fallopian tube. The Fallopian tubes connect the ovaries to the uterus. Another term for an ectopic pregnancy is a tubal pregnancy - however ectopic pregnancies can also occur in the ovary or cervix.

If the pregnancy is in the tube it does not receive enough blood supply and nutrition to survive.

Sometimes the ectopic pregnancy will continue to grow until the tube ruptures (breaks) – this can cause severe internal bleeding.

Early diagnosis and treatment is important to prevent life threatening bleeding and also, if possible, so the tube can be saved and it can continue to work.

What causes an ectopic pregnancy?

Conception (fertilisation of the egg) normally occurs in the outer end of the tube and the fertilised egg then moves down the tube to the uterus.

Anything that slows the passage of the fertilised egg can cause an ectopic pregnancy, for example

  • A previous pelvic infection
  • A previous ectopic pregnancy
  • Previous tubal surgery
  • Previous pelvic/abdominal surgery
  • Assisted reproduction (e.g. IVF)
  • Current use of an intra-uterine contraceptive device (IUCD or IUD)
  • Cigarette smoking

Most often no cause is found.

The symptoms of an ectopic pregnancy

An ectopic pregnancy may present with all the signs of pregnancy - that is a missed period and a positive pregnancy test - however some women may not realise or consider they are pregnant. 

If the pregnancy has implanted in the fallopian tube then unusual pain may occur. Sometimes the pain is associated with vaginal bleeding or spotting. The pain often becomes worse and may be associated with feeling faint and/or shoulder tip pain.

if the tube ruptures the woman may go into shock because of the large amount of internal bleeding.

Diagnosing an ectopic pregnancy

  • The pregnancy needs to be confirmed with a blood or urine test. The blood test is more accurate.
  • If the hormone level is high enough and there is pain and spotting, an ultrasound scan is done.
  • If the pregnancy sac is not seen in the uterus it is possible that there is an ectopic pregnancy.
    • The pregnancy sac may be seen in the tube on ultrasound, but sometimes it is difficult to diagnose an ectopic pregnancy, as the pregnancy sac may be too small to see and there may not be much pain.
  • If the diagnosis is unclear your doctor may decide to admit you to hospital to watch your progress and do further tests.
  • Your doctor may decide to do a laparoscopy if it seems possible that there is an ectopic pregnancy. This involves having a thin telescope inserted into the abdomen through the umbilicus (belly button) under a general anaesthetic, so that the tubes and ovaries can be seen clearly.

Treatment of an ectopic pregnancy

If an ectopic pregnancy is seen on ultrasound the doctor must decide how to best manage the situation.

  • During the laparoscopy often the pregnancy can be removed by squeezing it out from the end of the tube.
  • Sometimes a cut must be made in the tube to remove it.
  • If the tube is badly damaged it will be removed.
  • When a laparoscopy is done the hospital stay is usually 1 to 2 days long.

Occasionally a laparotomy has to be performed. This involves a cut in the skin just above the pubic hair line. This is done if the ectopic pregnancy is difficult to remove via the laparoscope, or if there is severe bleeding. In this case a blood transfusion may be needed, and is life saving. The stay in hospital may be several days.

Alternatively in specially selected cases medical management can occur using a drug called methotrexate. After having methotrexate treatment your doctor will get you to attend an assessment service on a regular basis to make sure that the pregnancy hormone level returns to normal, which is a value of less than five.

Emotions after an ectopic pregnancy

The loss of your pregnancy at any stage can have a huge impact on you and your partner. One day you are pregnant and planning your future life with your child, and then within a short time, your pregnancy ends. The ending of an ectopic pregnancy is a form of miscarriage – and the feelings that a woman and her partner may experience can be similarly difficult.

Each woman will cope with an ectopic pregnancy slightly differently.

  • Facing everyday life may be difficult for a while.
  • You may feel isolated, afraid to be alone, or you may not want to see anyone or continue your usual activities.
  • You may experience difficulty sleeping, vivid dreams or nightmares.

Whatever your feelings, allow yourself time to grieve, to cry, and to talk about the emotions you feel.

  • It can be a big help to find someone you can talk to, who will listen and understand.
  • If may help if you contact a support group and talk to other parents who have had a similar experience.

While you are recovering, do not expect too much of yourself, and try to be with the people you feel most comfortable around.

Your partner can also experience a wide range of feelings and may be unsure how to comfort and help you.

  • His feelings about the pregnancy will be different from yours.
  • You may each grieve in different ways and it is important to talk to each other and to be aware of each other’s feelings.

Looking ahead

Anyone who has experienced an ectopic pregnancy is likely to be fearful that it will happen again. Most women who have an ectopic pregnancy will not have one next time, but at least 12% (1 in 8 women) could have another ectopic pregnancy – especially if the tube ruptured or it is damaged.

It is normal to feel very anxious about any future pregnancies. It may help to talk about these feelings with your partner and your doctor. If you become pregnant again it is important to have an early ultrasound to find out the site of this new pregnancy.

Remember, you will feel better again and there are people you can talk to about this loss. These people include hospital social workers, chaplains, your doctor and SANDS members (in South Australia).

For friends and relatives

It is always hard seeing someone you care about going through a difficult experience. It is important not to say things like 'You can always have another baby' or 'It's all for the best'.

You need to be there to listen, and be patient if it takes time for your friend or relative to feel OK.

Support 

South Australia

  • The hospital you have been at may have a Women's Social Work service to provide support.
  • SANDS SA (Inc)
    SANDS (SA) is a support group in South Australia for parents and their family whose baby has died through stillbirth, neonatal death, miscarriage, ectopic pregnancy and medically advised termination.
    Phone 1300 072 637 (24 hours)

    The SANDS website has information for bereaved parents and also for their relatives and friends. There is a book list and some stories written by bereaved parents.
    SANDS SA

    There are SANDS groups in some other Australian states and information can be obtained from the SANDS Australia website 
    http://www.sands.org.au

    Australia

    • Pregnancy Loss Australia  
      •  Pregnancy and Infant Loss Support  for bereaved parents who suffer the loss of their baby or babies due to miscarriage, still birth, termination of pregnancy for foetal abnormality, and neonatal death. (Australia)
        http://pregnancylossaustralia.org.au/ 
      • Pregnancy Loss Australia has published a book 'You are not alone' which is available via their website.

    Reference

    Women's and Children's Hospital (South Australia) 'Ectopic pregnancy' 2011

    Further reading

    For more detailed information about ectopic pregnancy: 'South Australian Perinatal Practice Guidelines - Ectopic Pregnancy'
    'Ectopic pregnancy'

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    The information on this site should not be used as an alternative to professional care. If you have a particular problem, see your doctor or midwife.

     

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