Expert Advice

Everything you need to know about ectopic pregnancy

We all hope for the best when we're expecting a baby, yet not all pregnancies end in happiness. We answer your questions about ectopic pregnancy.

What is an ectopic pregnancy?

Ectopic pregnancy affects around one per cent of pregnancies in New Zealand, and can be life-threatening if not diagnosed and treated quickly.

Put simply, it means an "out of place" pregnancy. It occurs when a woman's fertilised egg gets caught somewhere outside the uterus, such as the fallopian tube (95 per cent of cases). Other sites include a C-section scar, an ovary, the cervix, or directly in the abdomen.

When this happens, the embryo continues to grow until the fallopian tube ruptures, resulting in severe abdominal pain and bleeding.

This can cause permanent damage to the tube or loss of the tube, and, if it involves heavy internal bleeding that's not treated promptly, it can even lead to death. That's why early diagnosis, immediate treatment and follow-up care are so important.

When is an ectopic pregnancy most likely to happen?

Ectopic pregnancy is usually diagnosed within the first 10 weeks of pregnancy. You might not even know you're pregnant yet, so it can be a big shock.

Who is at risk of an ectopic pregnancy?

Any sexually active woman can be at risk, and sometimes the cause is never determined, however medical experts have determined that ectopic pregnancies are more likely if you have had:

 A previous ectopic pregnancy
 Pelvic Inflammatory Disease (PID)
 Surgery on your fallopian tubes such as sterilisation
 Endometriosis
 The copper contraceptive coil (IUCD)
 Recently used the Morning After Pill (it is possible to become pregnant in the same cycle after trying to prevent pregnancy with emergency oral contraception)

Ectopic pregnancy is not hereditary, or related to abortion.

What are the symptoms of an ectopic pregnancy?

In some cases, women will experience no symptoms until the ectopic pregnancy has ruptured.

Symptoms appear early in the pregnancy and can be almost identical to those experienced in miscarriage, with the most common being the combination of a missed period and abdominal pain. They can also include the following:

 Spotting or abnormal vaginal bleeding (that often looks brown like prune juice)
 Shoulder tip pain (caused by internal bleeding irritating the diaphragm when you breathe in and out)
 Pain when you go to the toilet
 Diarrhoea
 Nausea or light-headedness
 Dizziness or weakness
 Increasing pulse rate or falling blood pressure
 Collapse (if the fallopian tube ruptures, the pain and bleeding could be severe enough to cause fainting)

How is an ectopic pregnancy diagnosed?

Ectopic pregnancy is often tricky to diagnose because it can present symptoms that can be suggestive of other conditions, such as gastroenteritis, miscarriage or even appendicitis.

The more you can tell your doctor about the changes and symptoms you've noticed, the more likely they are to be able to diagnose you.

If your symptoms suggest an ectopic pregnancy, medical staff will usually begin by giving you a pregnancy test. They will then give you an ultrasound, so that they can search for the embryo, and a blood test that measures pregnancy hormone levels to try to confirm a diagnosis.

Is there an ectopic pregnancy test?

There isn't a test for identifying women who may or may not have one.

What is the treatment for an ectopic pregnancy?

Treatment depends on the symptoms and how quickly an ectopic pregnancy is diagnosed. The common perception is that everyone with an ectopic needs an operation to deal with it but according to Fertility New Zealand a number of treatment options are available.

1.If there is evidence of serious bleeding producing shock, immediate treatment is essential. This is a surgical emergency and in most case a bigger operation (laparotomy) is performed. An experienced surgeon may also perform laparoscopic treatment. Conservative surgery to retain the fallopian tube, removing the ectopic may be employed when the ectopic has not ruptured and where the tube appears normal. The conservative surgical approach is called salpingotomy, where the ectopic is removed and the tube allowed to heal on its own. Salpingectomy (tubal removal) is the principal treatment where there is tubal rupture. Surgical treatment usually requires one to two days in hospital.

2.Expectant management is used when pain is less (or lessening) and there are indicators that the ectopic is a small one or it is not bleeding too much. It is also dependent on social circumstances, employment issues, previous history, etc. The expectant approach involves a close follow-up with hCG tests every two to seven days until the levels have returned to normal. The expectant management is successful in 90 per cent of selected patients. Living in a rural setting need not hinder an expectant plan providing the risk of rupture is considered to be low and the patient has ready access to secondary care hospital (less than three hours by car).

3.Methotrexate is a drug that destroys actively growing tissues such as the placental tissues that are supporting the pregnancy. It may be used as an injection in selected cases to avoid the need for surgery. Side effects include abdominal pain for three to seven days in 50 per cent of cases and mild symptoms of nausea, mouth dryness, mouth soreness and diarrhoea.

Can an ectopic embryo be moved into a safer position?

It is, sadly, not possible to move an ectopic pregnancy.

Can I have a successful pregnancy after I have had an ectopic one?

New Zealand's Family Doctors advises: There have been many long-term studies that have looked at the reproductive outcomes after the various forms of treatment. After salpingectomy, 49 per cent of those who wished to become pregnant had a subsequent normal pregnancy; after salpingostomy and methotrexate, the figure is closer to 60 per cent.

Even if one of your fallopian tubes is removed, you can still become pregnant naturally.

How long should I wait after an ectopic pregnancy before trying to conceive again?

It is likely you will be advised to wait three months or two full menstrual cycles (periods), whichever is the soonest, before trying to conceive if you have had surgery.

If you have had Methotrexate, you should wait until your HCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood tests) and then take a folic acid supplement for 12 weeks before you try to conceive. This is because the Methotrexate may have reduced the level of folate in your body, which is needed to ensure a baby develops healthily.