Ectopic Pregnancy

Ectopic pregnancies are pregnancies outside of the uterus. They commonly implant in the fallopian tubes which is potentially life threatening. Less then 2% of all pregnancies. Rarely the pregnancy can implant on the ovaries, cervix, at the corner of the uterus or even in the abdominal cavity.

Normal growth and development of the foetus cannot proceed in an ectopic pregnancy.

The initial sign or an ectopic pregnancy is usually vaginal bleeding, most commonly light or spotty, accompanied by cramping, abdominal or pelvic pain. Another symptom of an ectopic pregnancy is pain that accompanies nausea and vomiting, as well as dizziness or fatigue. If the fallopian tube ruptures in a woman with tubal ectopic pregnancy, it can cause sudden and sever pain in the abdomen and the internal bleeding. Light internal bleeding can cause nerve irritation which can lead to pain in other parts of the body.  The most common areas for pain to be felt are the right shoulder. Extensive bleeding in the abdomen can cause an increased heart rate, lightheadedness, fainting and shock.

Most of the time no cause is found. Normally conception happens in the fallopian tube and later the pregnancy travels down to and implants in the uterine cavity. Anything which delays this process can lead to an ectopic pregnancy. This could be secondary to medication, previous infection or tubal damage.

  • Women who have previously had ectopic pregnancies are more likely to have another.
  • Women who have inflamed uterine tubes or an infected uterus, uterine tube or ovary, usually due to diseases such as gonorrhea or chlamydia, or history of pelvic inflammatory disease are more likely to have an ectopic pregnancy.
  • Women with fertility issues are at a higher risk of having an ectopic pregnancy.
  • Women who have had IVF are at an increased risk of an ectopic pregnancy
  • Women who have damaged uterine tubes are more at risk.
  • Women who fell pregnant with an intrauterine device.
  • Women who have  previously had tubal device.
  • Women who have had tubal ligation reversed
  • Falling pregnant after us of emergency contraception(morning after pill)
  • Women who smoke

Ectopic pregnancy is usually diagnosed with ultrasound.

Laparoscopic surgery is usually required for an ectopic pregnancy. Many women need a salpingectomy (removal of fallopian tubes). In some cases conservative management (wait and watch) can be utilised as some extopic pregnancies can resolve spontaneously. Occasionally an injection of methotrexate ( medication) is used in treatment of ectopic pregnancy.

Careful observation is needed for all women found to have ectopic pregnancies. Women who have previously had ectopic pregnancies and who have become pregnant again will need an early ultrasound follow up and care as their chance of having another ectopic pregnancy is increased by ten – fold.