An ectopic pregnancy happens when an embryo develops outside the womb (uterus). Discover why it happens, how common it is, and the signs and symptoms to look out for. Also learn how ectopic pregnancy is treated, and whether it can affect your fertility.
How common is ectopic pregnancy?
It happens in about one in every 90 pregnancies in the UK.
About 98 per cent of ectopic pregnancies implant in one of the fallopian tubes, which is why it’s also known as a tubal pregnancy. The remainder implant either in the abdomen, the ovary, the cervix, or within a caesarean scar.
As a tubal pregnancy grows, it causes pain and bleeding. If it’s not treated it can make your tube rupture, causing internal bleeding.
This is a medical emergency and can be fatal if not treated. Sadly, the pregnancy won’t survive, and cannot be moved to your womb. A doctor will remove the pregnancy tissues. The affected fallopian tube is usually also removed.
When is an ectopic pregnancy likely to happen?
An ectopic pregnancy may be found at any time between five weeks and 14 weeks of pregnancy. However, it is most likely to be found at about six weeks of pregnancy, as most women experience symptoms about two weeks after they miss a period.
Why does an ectopic pregnancy happen?
An egg normally spends about five days travelling down the tube from your ovary to your womb, where, if fertilised, it implants and begins to develop. If you have an ectopic pregnancy, the egg usually hasn’t travelled far enough when it implants, and starts to develop in the tube.
This may happen due to damage to your fallopian tube, which causes your tube to be too narrow for the egg to reach its destination.
Am I at risk of having an ectopic pregnancy?
An ectopic pregnancy can happen to any woman, and about one in three women who have one have no known risk factors for it. The circumstances that make it much more likely include:
- If you’ve had pelvic inflammatory disease (PID), most often caused by chlamydia. This can cause damage and scarring to the fallopian tubes.
- If you’ve had any abdominal surgery, including your appendix being removed, or a caesarean section, or surgery on your fallopian tubes, such as a sterilisation reversal.
- If you’re pregnant after IVF treatment. You should have an early scan to check where the embryo has implanted.
- If you become pregnant while using a contraceptive intrauterine device (IUD), or while taking the contraceptive mini-pill.
- If you’ve had a previous ectopic pregnancy, your risk increases from about one in 90 to one in 10.
Other less important risk factors include if you smoke or you are aged 40 or above.
What are the symptoms of an ectopic pregnancy?
Recognising the symptoms isn’t easy. It may feel like period pains. Or it may feel like you’re having a miscarriage, with cramping and slight bleeding. Symptoms may come on gradually or suddenly, or you may not feel any symptoms at all during the early stages.
The following symptoms will help you to identify an ectopic pregnancy:
- Signs of pregnancy, such as a missed period or a period that is late, or breast tenderness.
- Unusual vaginal bleeding, different from your normal period. It may be lighter, and brighter, or darker red than usual, or watery. Some women describe it as looking like prune juice. There may or may not be clots.
- Mild to severe pain in your lower abdomen or pelvis. This may come on gradually or suddenly, and may be one-sided. If you experience this and you think you may be pregnant, see your doctor.
If it’s not diagnosed early, your tube may be stretched by the growing embryo, and rupture. This will usually cause internal bleeding, and these signs and symptoms:
- Feeling light-headed, faint or dizzy.
- Diarrhoea or pain when you poo.
- Shock, or collapse, due to severe internal bleeding.
- Shoulder-tip pain (pain where your shoulder ends and your arm begins), if internal bleeding irritates other internal organs, such as your diaphragm. The pain may be worse when you lie down and it may be unaffected by taking painkillers.
What should I do if I have ectopic pregnancy symptoms?
See your doctor immediately, or go to hospital. If you see your doctor, she will ask about your symptoms, examine your tummy, and may do an internal examination. If your fallopian tube has ruptured, you’ll have surgery right away. But in most cases, ectopic pregnancies are caught early enough for tests to be done and surgery, if it’s needed, to be planned.
You will probably be referred to an early pregnancy unit for a vaginal ultrasound scan to locate the pregnancy. If the scan isn’t conclusive, you may need another scan in a week or so.
You may have a pregnancy test to confirm the pregnancy, and to measure the levels of the pregnancy hormone hCG (human chorionic gonadotrophin) in your blood. Lower than normal hCG levels may be a sign of an ectopic pregnancy. You may need several blood tests to check your hormone levels.
If your doctor suspects an ectopic pregnancy, but it hasn’t been confirmed by ultrasound, she may suggest an investigative operation under anaesthetic. This is called a laparoscopy (also known as keyhole surgery). Your doctor will place a narrow viewing instrument into your belly through a tiny cut to inspect your tubes.
How is an ectopic pregnancy treated?
The treatment that you’re offered will depend on how far the pregnancy has developed, your hormone levels, and whether you have symptoms such as pain or blood loss. Options include:
A wait-and-see approach (expectant management)
If your ectopic pregnancy is identified very early on (within six weeks) and you’re feeling well, with no symptoms, you may be given the option of having no treatment. This ‘wait-and-see’ option is known as expectant management.
About half of ectopic pregnancies stop growing and miscarry on their own. If there’s no visible heartbeat when the pregnancy is scanned, and if your pregnancy hormone levels are low, then expectant management may be suitable for you. However, between one in seven and one in 10 women who opt for this may still need medical treatment or surgery later on.
Medical treatment
Your doctor may recommend this if you’re in early pregnancy, with low levels of the pregnancy hormone, no visible heartbeat, and you have minimal symptoms, with no bleeding. The drug methotrexate is given by injection into your thigh or bottom, and stops the pregnancy developing. This is more likely to be an option if your ectopic pregnancy has been diagnosed by ultrasound and blood tests.
After you’ve been given the drug, the pregnancy tissues will be reabsorbed by your body. You will then experience bleeding for a couple of weeks afterwards. You may need more than one injection of methotrexate.
Surgery
This will be recommended if you’re in a lot of pain, if the pregnancy is advanced, if there is a visible heartbeat, or your pregnancy hormones are above a certain level. Usually, if an ectopic pregnancy is discovered or confirmed during laparoscopy, the surgeon will remove it at the same time.
Often the pregnancy and the fallopian tube are removed (salpingectomy), as this reduces your risk of having another ectopic pregnancy. Two additional small incisions are needed to do this. If you are rhesus negative (RhD negative), you’ll be offered a dose of anti-D immunoglobin.
It’s possible to remove an ectopic pregnancy from your fallopian tube and preserve the tube if it hasn’t ruptured or become severely damaged. This is called a salpingotomy. It may be recommended if you only have one tube, or if your other fallopian tube doesn’t look healthy.
Your doctor will discuss your options with you, and will explain the risks and benefits of each one.
Removing an ectopic pregnancy is usually done as keyhole surgery, which uses small incisions. Serious complications as a result of this type of surgery are uncommon. Keyhole surgery has advantages over abdominal (open) surgery because:
- recovery is quicker than from open surgery
- there’s less blood loss
- it means a shorter hospital stay
- you’ll need less pain relief
But if your tube has ruptured, doctors may recommend that you have open abdominal surgery. That’s because it’s the quickest way to reduce blood loss.
Up to one in five women who have an ectopic pregnancy removed without losing their tube may have pregnancy tissues left behind and need further treatment. These tissues continue to grow even after the ectopic pregnancy has been removed.
A persistent ectopic pregnancy can be treated with an injection of methotrexate to prevent any further tissue growth, or by further surgery to remove the tube. There is some evidence that giving an injection of methotrexate after surgery can help to avoid a persistent ectopic pregnancy.
In some cases, you may be offered the choice between either medical or surgical management. Rest assured that your doctor will talk you through your options, and you will be given support throughout.
Will having an ectopic pregnancy affect my fertility?
It may do, as it depends on the health of your fallopian tubes, or remaining fallopian tube if you had to have one removed.
The cause of your ectopic pregnancy, such as a previous pelvic infection, may have some impact on your fertility.
If you have one healthy tube, then you have a good chance of conceiving again, as you can still ovulate. The good news is that about six out of 10 women who have had an ectopic pregnancy are able to conceive again and have a successful pregnancy.
If you’re unable to conceive naturally, then an assisted conception treatment such as IVF may be an option.
What is my risk of having another ectopic pregnancy?
You have about a one in 10 risk of having another ectopic pregnancy. But this means that you have a nine out of 10 chance of not having another one.
This risk may depend on the type of surgery you had, and whether there is any underlying damage to your remaining tube or tubes. As ectopic pregnancies are usually caused by past damage to the tubes, there is little you can do to prevent one from happening in the future.
After treatment, your hospital may offer a follow-up appointment, or you can make an appointment with your GP. You can then talk through what happened with a medical professional, and ask advice about future pregnancies.
If you become pregnant again, see your doctor as soon as you can. You can either be referred or you can refer yourself to an early pregnancy unit for an early scan at about six weeks to seven weeks. This will check that your pregnancy is developing in the right place.
How long should I wait before trying again?
The impact of an ectopic pregnancy can be hard to deal with. If possible, allow yourself to heal, both emotionally and physically, before trying again.
Ask your doctor for advice and wait until you feel ready. If you’ve had keyhole surgery, you should wait until you’ve had at least two full menstrual cycles before trying to conceive again. If you’ve had abdominal surgery, it’s best to wait six months to allow the scarring to heal.
If you’ve had the drug methotrexate, you’ll need to wait for at least three months before trying for a baby, to make sure the drug has left your system completely.
Where can I go for advice and support?
Having an ectopic pregnancy can be a devastating experience. You’ll be trying to cope with a pregnancy loss that may have affected your fertility, and you may have had major surgery.
It’s normal to feel painful emotions, such as grief and sadness, when you lose a pregnancy. The Ectopic Pregnancy Trust and the Ectopic Pregnancy Foundation can offer you advice and support. You’ll also find plenty of support in our community from other women who have experienced an ectopic pregnancy.