27 June 2018

Ectopic pregnancy: what causes it and what are the symptoms, diagnosis and treatment like?

By the Editorial Comitee IVI Blog


An ectopic pregnancy occurs when a fertilised egg becomes lodged outside the uterus, usually in one of the fallopian tubes. In this article we review what are the possible ectopic pregnancy causes, what are the signs and how you might recognise any ectopic pregnancy symptoms, how the condition is diagnosed and finally ectopic pregnancy treatment.

Sadly, this condition is not all that uncommon. When the condition occurs, although normally it can be treated without any long-term damage, it is not possible to save the pregnancy. People who experience this will, as a result, experience not only the physical symptoms of ectopic pregnancy pain but also the same feelings of loss and grief as if they had suffered a miscarriage. Medical advice is therefore to give yourself and your partner time to recover before trying again.

What exactly is an ectopic pregnancy?

When a fertilised egg implants itself and starts to develop anywhere outside the womb, this is an ectopic pregnancy. The most common site in inside one of the fallopian tubes. These are the tubes connecting the ovaries to the womb. If a fertilised egg becomes lodged in one of them, it can’t develop into a baby and your health could also be at risk if the pregnancy continues.

What causes an ectopic pregnancy?

There is no one definitive ectopic pregnancy cause, but there are several factors that increase the risk. These include pelvic inflammatory disease, previous surgery on the fallopian tubes and becoming pregnant while using a contraceptive intra-uterine device. Other risk factors include a history of a previous ectopic pregnancy, smoking, and increasing age: the risk is highest among women between the ages of 35 and 40. There are also risks associated with endometriosis (although the exact link is not clear), abdominal surgery, the ‘mini pill’ which affects the motility of the fallopian tube and emergency contraception.

What are the possible ectopic pregnancy symptoms?

Symptoms vary and are not always consistent. In fact, symptoms including ectopic pregnancy pain are not always present, and the condition could be picked up only during a routine pregnancy scan. Where symptoms do occur, they tend to develop and be noticed between the 4th and 12th week of pregnancy. The most common ectopic pregnancy signs, in addition to a missed period and other normal signs of pregnancy, can include:

  • stomach pain, usually low down on one side
  • vaginal bleeding which is a bit different from a normal period, for example stopping and starting or very dark brown in colour, or a watery brown discharge
  • discomfort when going to the toilet
  • pain in the tip of the shoulder – it’s not known exactly why this occurs, but it could be a sign of an ectopic pregnancy causing some internal bleeding, so you should get immediate medical advice right away if you experience it.

However, these symptoms are not always signs of a serious problem and could be caused by other conditions, for example a stomach bug.

More serious rupture symptoms including ectopic pregnancy pain

In quite rare cases, an ectopic pregnancy can develop to a size where it ruptures the fallopian tube, leading to sudden and severe ectopic pregnancy pain. This is a serious condition requiring treatment in the form of surgery to repair the ruptured tube as soon as possible. Ectopic pregnancy signs and symptoms in the event of a rupture consist of:

  • sudden, sharp and intense stomach pain
  • feeling very sick
  • suddenly becoming dizzy
  • fainting
  • very pale skin

If you were to experience these symptoms, it would be a medical emergency and you should call for an ambulance or go immediately to your nearest Accident and Emergency Department for attention.

How is an ectopic pregnancy diagnosed?

Diagnosis can be difficult, since symptoms are often not easy to distinguish from other conditions. There are three main methods used for diagnosis. These are vaginal ultrasound, blood tests and keyhole surgery.

Vaginal ultrasound for ectopic pregnancy diagnosis

The most common diagnostic procedure is a vaginal ultrasound scan. In this procedure, a small probe is inserted into your vagina. Its very small size means that this is an easy process and there’s no need for local anaesthetic. Sound waves emitted by the probe are bounced back to create a close-up image of your entire reproductive system on the operator’s monitor. Often this shows whether a fertilised egg has become embedded in one of your fallopian tubes, although this method of diagnosis is not always definitive as occasionally the scan results are not clear enough for the condition to be spotted.

Blood test to diagnose ectopic pregnancy

If a blood test is required to confirm an ectopic pregnancy, it will be carried out twice, 48 hours apart, to see how the levels of the pregnancy hormone human chorionic gonadotropin (hCG) change over time. This is a way to identify an ectopic pregnancy which has not been picked up by an ultrasound scan. It is effective because the level of hCG tends to be lower and increase at a slower pace in an ectopic pregnancy than in a normal pregnancy. The results of these tests can also be useful in determining the correct subsequent treatment.

Keyhole surgery diagnosis for ectopic pregnancy

If neither of the previous methods provides a clear diagnosis, or if the ectopic pregnancy signs are all there but the exact location has not been identified, keyhole surgery may be carried out. This is known as a laparoscopy. This is a surgical procedure that is carried out under general anaesthetic. A small incision is made in your stomach and the laparoscope – a viewing tube – is inserted, enabling direct visual examination of the womb and fallopian tubes. During this procedure, if the presence of an ectopic pregnancy is confirmed, small surgical instruments may be used to terminate it in order to avoid the necessity of further surgery later on.

What treatments are recommended for an ectopic pregnancy?

Once the condition has been diagnosed, ectopic pregnancy treatment is normally needed. The treatment of choice is, of course, dependent on a number of factors to do with your exact condition. One option is expectant management, whereby your condition is monitored to establish whether further treatment is necessary. Alternatively medication can be used to stop the pregnancy from progressing. Finally, surgery to terminate the pregnancy, in some cases along with the removal of the affected fallopian tube, may be carried out. Which of these treatments is the most suitable in your case would depend on your ectopic pregnancy symptoms, how advanced the pregnancy is and your blood levels of hCG.

What happens next: trying for another pregnancy

Whatever the ectopic pregnancy cause in your individual case, the loss of a pregnancy can be a deeply traumatic event for you and your partner. It’s usually advisable to give yourselves some recovery time before planning a further pregnancy. The normal medical advice is to wait until you’ve had two normal periods to make sure your body has stabilised. In particular, if your ectopic pregnancy treatment involved the use of the drug methotrexate, the usual advice is to wait at least 3 months since the after-effects of the medication can be harmful to the baby if you become pregnant during this period. If you need further support, you should not hesitate to contact your local counselling service in order to deal with the emotional impact this type of pregnancy can have.

When you feel both physically and emotionally ready and decide to take the plunge, you may like to browse our article on tips for successful conception. The chances of a further ectopic pregnancy are slightly higher if you’ve had one before, but are still quite slim at around 10%.

Will I need IVF treatment following an ectopic pregnancy?

The good news is that most women who have had an ectopic pregnancy will be able to get pregnant again naturally, even if they’ve had a fallopian tube removed. In fact, over 65% of affected women go on to have a successful pregnancy within a period of 18 months. However, in some cases assisted fertility treatment is advisable. Here too the chances are excellent, and IVI’s proud record is that over 27 years, the IVI Group has helped to bring 160,000 babies into the world. You may find that you are one of the people who, having undergone an ectopic pregnancy, are in need of IVF treatment to help with achieving a further pregnancy. If so, why not have a look at our video explaining how the process works?

When you feel ready, give a call or get in touch through our contact form. We’re here to help.


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