Ectopic pregnancy

What is an ectopic pregnancy?

For most mothers, pregnancy runs its course without any major problems. However, in about one in every 100 pregnancies one of the most devastating complications of pregnancy occurs – an ectopic pregnancy.

Normally eggs makes its way from the ovary to the womb through one of the fallopian tubes, where it is fertilised by a sperm. The fertilised egg travels to the womb, where it implants in the wall and continues to grow.

However, sometimes the embryo implants itself outside the womb, most often in the fallopian tube, and this is known as an ectopic pregnancy. The embryo can also implant in the ovary, the abdomen or the cervix.

Causes and risk factors of ectopic pregnancy

Anything that obstructs or slows the movement of the egg can increase the risk. Infections in the fallopian tubes can leave them scarred, which will hinder movement, or there may be a physical blockage caused by previous surgery or injury.

Hormones - particularly those used in contraceptive pills and devices - can also affect the rate of movement of the egg. Women who have been affected by pelvic inflammatory disease or endometriosis are at higher risk. So too are women who have had abdominal surgery, used a coil for contraception, or taken the progestogen-only mini pill, but become pregnant anyway. There may also be an increased risk among women who take the morning after contraceptive pill to no avail (i.e. it fails to stop pregnancy) - although this is still unclear.

Women who become pregnant despite having been surgically sterilised have a 60 per cent chance of an ectopic pregnancy. And women who have had a previous ectopic pregnancy, are at greater risk of a second one.

Ectopic pregnancies are on the rise with the rate nearly tripling from 1970 to 1980. About half are estimated to be due to the increase in sexually transmitted infections such as chlamydia which can damage the fallopian tubes.

Ectopic pregnancy - treatment and prevention

Because the pregnancy is growing in the wrong place, in tissues that are not able to expand and accommodate the embryo, the fallopian tube may rupture or the implanted pregnancy may become dislodged.

This can cause abdominal pain which may build from a niggle or suddenly be severe, and can lead to massive internal bleeding – with sudden collapse and possibly death - for the mother, as well as loss of the baby.

Urgent surgery to remove the ectopic and repair the damage as far as possible is often needed. Occasionally a drug called methotrexate is given. This stops the pregnancy and causes the body to reabsorb it. After an ectopic a woman’s fertility is likely to be reduced. She also has an increased risk of another ectopic in further pregnancies.

Because of the life threatening nature of the condition, early diagnosis is essential. severe pain low down in the tummy, perhaps on one side only, vaginal bleeding or a watery brown discharge, pain in the shoulders, feeling dizzy or faint and pain when having a bowel movement. If a woman experiences any of these symptoms and thinks she might be pregnant, even if she has not done a test, she should consult her GP or a doctor as a matter of urgency.

At present there is no way to prevent an ectopic from occurring.

Further information

• Ectopic Pregnancy Trust
• Website: www.ectopic.org.uk
• Telephone: 020 7733 2653