An ectopic pregnancy is one that develops somewhere outside the uterus, and can be life-threatening. Recognising the symptoms and seeking prompt treatment with an experienced gynaecologist is crucial for your health and future fertility.
Ectopic pregnancies occur in around 1-2% of all pregnancies, with higher rates found in women over the age of 35 years. Sadly, these pregnancies cannot result in a live birth and must be managed with specialised care to prevent serious harm to the mother.
The most common site of an ectopic pregnancy is in one of your fallopian tubes, known as a tubal ectopic pregnancy. Less commonly, an ectopic pregnancy may develop in your abdomen, ovary, cervix, or even in the scar tissue of a previous caesarean section; this is termed a non-tubal ectopic pregnancy.
Certain problems with the fallopian tube can prevent a fertilised egg from traveling to the uterus for implantation. Fallopian tubes may become scarred, blocked, or distorted from:
Women who have fallen pregnant despite having an intrauterine device (IUD) in place, are at a higher risk of an ectopic pregnancy, though such occurrences are extremely rare. Certain medications used in fertility treatments can also increase your risk.
Ectopic pregnancy symptoms may initially resemble those of a typical early pregnancy. This includes:
However, some women may not experience any symptoms during the early stages of an ectopic pregnancy. As the pregnancy progresses, more concerning signs and symptoms can evolve, particularly if the site of the pregnancy (e.g. the fallopian tube) ruptures. This can result in severe internal bleeding and shock, which may present with fainting, shoulder pain, intense pressure in the rectum, severe lower abdominal pain, and low blood pressure.
Ectopic pregnancies are usually diagnosed with a series of blood tests combined with pelvic ultrasound. Ectopic pregnancy treatment depends on the size and location of the implanted embryo. The specific circumstances, including the pregnancy’s stage of development and location, your symptoms, and overall health at the time of diagnosis will guide Dr Huang’s treatment recommendations.
In cases where the ectopic pregnancy was detected early and there is low risk of rupture, a drug called methotrexate may be administered to stop further growth of the embryo and placental tissue. This option preserves your fallopian tube and avoids surgery, but further pregnancy attempts should be postponed for at least three months after this treatment.
Laparoscopic surgery is the most common treatment for ectopic pregnancies, especially in emergency situations or when methotrexate medication is not suitable. Laparoscopy is a minimally invasive surgical procedure performed via keyhole incisions in your abdomen with the aid of a long, thin camera. Ectopic pregnancy surgery involves removing the pregnancy tissue and potentially also the affected fallopian tube. After ectopic pregnancy surgery, it is recommended to wait for at least six weeks before you start trying to conceive again.
In very rare and specific cases, close monitoring may be appropriate as some ectopic pregnancies can terminate on their own and self-resolve without intervention. This is suitable only for very small ectopic pregnancies that are asymptomatic, and if you are in good general health. For expectant management of an ectopic pregnancy to be suitable, you must meet certain criteria with your pregnancy hormone tests and ultrasound scans.
Women who have had one ectopic pregnancy are unfortunately at a higher risk of another ectopic pregnancy compared to women who have never had an ectopic pregnancy. Despite this, your chances of a pregnancy developing in the usual place inside your uterus is still relatively higher than having a recurrent ectopic pregnancy, with 65% of women establishing a normal pregnancy within 18 months of an ectopic one.
Due to the elevated risk of a recurrent ectopic pregnancy, any future pregnancies should include an early scan to ensure it is developing in the right place.
