Ectopic Pregnancy

Ectopic pregnancy is a pregnancy that is not in the usual place within the uterus (womb) but develops outside the uterus.

The most common place that ectopic pregnancy occurs is in one of the fallopian tubes. Rarely, an ectopic pregnancy takes place in the abdomen, ovary or cervix (neck of the uterus). These pregnancies will not develop normally and are associated with risks to the mother.

Recognising the symptoms, understanding the causes, and knowing the treatment options are crucial for women’s health

Statistics & Risk Factors

Ectopic pregnancies occur in approximately 1-2% of all pregnancies. However, the incidence varies depending on risk factors that can cause the fallopian tube to be scarred, damaged or the shape is changed. Factors that can increase risks for an ectopic pregnancy include:

History of fallopian tube infection such as pelvic inflammatory disease (PID), chlamydia and gonorrhoea
Previous ectopic pregnancies
Previous surgery on the fallopian tubes or in the pelvic area
Medication used in fertility treatment
Women who get pregnant while an intrauterine device (IUD) is in place

The condition is a leading cause of pregnancy-related first-trimester deaths, highlighting the importance of early detection and management.

Symptoms & Diagnosis

Symptoms of an ectopic pregnancy may initially resemble those of a typical early pregnancy including absence of menstrual periods (amenorrhoea), breast pain, lower back pain, nausea, as well as abnormal bleeding, lower abdominal or pelvic pain and mild cramping on one side of the pelvis.

However, some ectopic pregnancies can be symptoms free.
As ectopic pregnancy progresses, it can evolve into more concerning signs. The major risks of an ectopic pregnancy are associated with it rupturing, which can be associated with fainting, shoulder pain, intense pressure in the rectum, severe lower abdominal pain and low blood pressure.

Ectopic pregnancies are usually diagnosed with a combination of blood test(s) (often more than one) and a pelvic ultrasound.

Treatment Options

Treatment for an ectopic pregnancy depends on the size and location of the pregnancy. Treatment options include non-surgical with medication, or surgical methods. The specific circumstances, including the pregnancy’s size and location, the symptoms, and overall health at the time of diagnosis will determine which method of treatment is more appropriate

Medication: Methotrexate, a drug that stops the growth of the pregnancy tissue, is used in cases where the ectopic pregnancy is detected early, and there is no immediate risk of rupture. This option preserves the fallopian tube and avoids surgery. Pregnancy should be avoided for 3 months after completion of this treatment.
Surgical Intervention: Laparoscopic surgery (operating with the aid of a thin long camera through small incisions in the abdomen) is the most common treatment for ectopic pregnancies, especially in emergency situations or when medication is not an option. The procedure may involve removing the ectopic pregnancy and potentially the affected fallopian tube.
Monitoring: In very rare and specific cases, if the ectopic pregnancy is small and causing no symptoms, close monitoring may be appropriate, as some ectopic pregnancies resolve on their own without treatment.

Implications for Future Pregnancies

Women who have had one ectopic pregnancy are at a higher risk of having a recurrent ectopic pregnancy. However the chances of a future pregnancy developing inside the uterus is still higher than another ectopic pregnancy. Therefore, in future pregnancies, it is important to have an early pregnancy scan to ensure that the pregnancy is developing in the right place.

Conclusion