Around one in 90 pregnancies in the UK is a diagnosed ectopic pregnancy – that’s around 11,000 pregnancies every year (i). An ectopic pregnancy is a serious condition that can be life threatening – however it’s rare these days for women to die as a result of having one (though according to the Ectopic Pregnancy Trust, sadly there are an average of three maternal deaths each year in the UK and Ireland caused by ectopic pregnancy (ii)).
But what is an ectopic pregnancy exactly, and why is it so serious?
The word ectopic means out of place (it originates from the Greek word ektopas). So an ectopic pregnancy is a pregnancy that happens out of its normal place (you may have also heard the term ectopic heartbeat, which typically means an extra or a skipped heartbeat).
The normal place for a pregnancy – and the only place for a pregnancy to survive – is the uterus (womb): the term for this is an intrauterine pregnancy. But in an ectopic pregnancy the fertilised egg implants itself outside the uterus.
Normally, after ovulation an egg from one of your ovaries is released and drawn into the end of one of two fallopian tubes (these are structures on either side of the uterus that connect the ovaries to the uterus). The egg then travels along the fallopian tube towards the uterus. If you’ve had sex, your egg will usually meet sperm at some point during its journey and become fertilised. When that happens, the fertilised egg – having reached the uterus – will implant itself into the lining of the uterus (the endometrium) and develop into a foetus.
Sometimes, though, the fertilised egg gets waylaid for some reason or other. And instead of reaching the uterus, its journey can become delayed or stopped, and it can start to develop in some other part of your body.
Where do ectopic pregnancies develop?
The most common place for an ectopic pregnancy to develop in is a fallopian tube. When this happens it’s also known as a tubal pregnancy or sometimes a fallopian tube pregnancy. According to the Ectopic Pregnancy Foundation, more than 90 per cent of ectopic pregnancies are tubal pregnancies (iii):
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Most ectopic pregnancies – around 70 per cent – develop in the widest part of a fallopian tube, called the ampulla
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The narrow part of a fallopian tube – the isthmic – is where approximately 12 per cent of ectopic pregnancies develop
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Around 11 per cent of ectopic pregnancies are found in the fimbriae – thin, finger-like appendages found at the end of a fallopian tube closest to the ovary
Ectopic pregnancies can develop on an ovary too, though this is very uncommon. Meanwhile around one in 1,800 pregnancies is an ectopic pregnancy that develops in scar tissue caused by a previous caesarian-section birth. Other sites where an ectopic pregnancy can develop include the cervix, the abdominal cavity and the interstitium, which is fallopian tube tissue found within the uterus wall – though all of these happen very rarely (according to the Royal College of Obstetricians & Gynaecologists only three to five out of every 100 ectopic pregnancies occur outside of the fallopian tubes (iv)).
Heterotopic pregnancies, meanwhile, are pregnancies where both an intrauterine and ectopic pregnancy develop at the same time – experts have different opinions on how common these are, with statistics suggesting they account for one in 4,000 to one in 30,000 pregnancies (v).
What are the signs and symptoms of ectopic pregnancy?
Ectopic pregnancy symptoms vary from one woman to another, with some experiencing several symptoms and others having no symptoms at all – indeed, some women aren’t aware of the problem until it’s picked up during a routine ultrasound scan. According to the NHS, when these symptoms happen they tend to develop between the fourth and 12th week of pregnancy (vi).
One of the early signs of ectopic pregnancy is a missed period or any other sign of pregnancy such as nausea, breast tenderness and frequent urination, since any pregnancy has the potential to be an ectopic one (even a positive pregnancy test is considered a potential sign of ectopic pregnancy).
Vaginal bleeding is another sign, though this is fairly common during pregnancy and doesn’t necessarily mean you have a problem – though if you do experience vaginal bleeding it’s always a good idea to talk to your GP or another health professional about it, just in case. Some women may also mistake vaginal bleeding during pregnancy as their regular period and not realise they’re pregnant – however this type of vaginal bleeding tends to start and stop more than a period, plus it’s often watery and dark brown in colour.
Other tubal pregnancy symptoms – and, indeed, symptoms of any type of ectopic pregnancy – include:
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Abdominal pain (this can often be low down on one side and develop suddenly or come on gradually over several days)
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Pain in the tip of your shoulder (this is caused by blood leaking into your abdomen and irritating the diaphragm muscle in your chest – it can also be a sign that your condition is getting worse). This tends to develop alongside other symptoms as well as a general feeling of unwellness
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Diarrhoea and vomiting
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Pain and discomfort while urinating or having a bowel movement
If you have one or more of these symptoms or if you just think you may be pregnant, contact your GP, even if you haven’t taken a pregnancy test yet.
Do you need emergency help?
Ectopic pregnancy pain, however, can become more severe if you have a tubal pregnancy where the egg has grown large enough to split open – or rupture – the fallopian tube. You may, for instance, feel a sharp, sudden, intense pain in your abdomen often combined with nausea, dizziness and feeling faint or actually fainting, and you may look very pale. If this happens you will need emergency surgery to repair the rupture and stop the bleeding, so it’s essential that you or someone else calls 999 for an ambulance immediately.
What is pregnancy of unknown location?
If you have a PUL it means your pregnancy test is positive but no pregnancy has been identified on an ultrasound scan. One of the reasons this may happen is that your pregnancy is ectopic, but there are two other possibilities too:
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Your pregnancy is very early and too small to be picked up on a scan
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You may have miscarried (pregnancy tests can still be positive for up to three weeks following a miscarriage)
Women diagnosed with a PUL will usually have regular blood tests to check their pregnancy hormone levels and treated accordingly once a diagnosis has been made.
Ectopic pregnancy causes
Many ectopic pregnancies have no obvious causes, but you may be more likely to develop one if any of the following apply to you:
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You’ve had an ectopic pregnancy previously
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You’re aged 35 or older
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You’ve had fertility treatment (IVF treatment can, for instance, cause embryos to travel into a fallopian tube during the implantation stage)
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You’ve had pelvic inflammatory disease (PID) or a history of other pelvic infections
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You have endometriosis
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You’ve had an operation on your fallopian tubes
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You’ve had abdominal surgery – for instance you’ve had your appendix removed or a caesarean section
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You use an intrauterine contraceptive device (IUCD) – studies show that when such a device fails, the risk of a pregnancy being ectopic is very high (almost 50:50, some suggest) (v)
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You smoke
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You’ve become pregnant while using a progesterone-only contraceptive method
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You have a history of sexually transmitted infections (STIs) such as chlamydia or gonorrhoea
According to the Ectopic Pregnancy Trust, while it hasn’t yet been proven there may be a biological plausibility that using emergency contraception could increase the risk of ectopic pregnancy too (vii).
How is an ectopic pregnancy diagnosed?
Since ectopic pregnancy shares some of its symptoms with other conditions – such as miscarriage, pelvic inflammatory disease, endometriosis and gastroenteritis – it can often be tricky to diagnose. However, if you do have some of the symptoms and a pregnancy test shows you’re pregnant, your GP may refer you to an early pregnancy assessment service for further investigations. The ectopic pregnancy tests you may be offered can include blood tests, an ectopic pregnancy scan called vaginal ultrasound or a transvaginal scan, or – where these don’t provide a clear result – surgery.
How is an ectopic pregnancy treated?
If you’re diagnosed with an ectopic pregnancy it’s normal to feel worried and emotional, since it means it’s not possible to save the pregnancy. Indeed, ectopic pregnancy is classed as a type of miscarriage, so you may experience the same feelings of loss that a miscarriage can cause.
However it’s important that you get the treatment you need, as it can prevent serious medical problems from developing and – potentially – save your life. Your treatment options at this point will usually include observation, medication and, if needed, ectopic pregnancy surgery:
Observation This is often called watchful waiting and monitoring or expectant managing. It’s usually only offered to women who are still in the early stages of pregnancy and who also have no or just a few symptoms. You won’t usually need to stay in hospital but you will need blood tests every few days until your pregnancy hormones drop and show that you’re no longer pregnant. This option is possible because some ectopic pregnancies end by themselves without causing any problems. But you must get medical advice straight away if you develop any more symptoms. Meanwhile if the blood tests show your pregnancy hormone levels aren’t falling, you’ll usually need another treatment.
Medication Drug treatment is also an option for early ectopic pregnancies where pregnancy hormone levels are still quite low. The medicine used is called methotrexate, which is a drug normally used in cancer treatment. It works by stopping the pregnancy from developing and is given as an injection, with most women only needing one dose (some, however, may need a second injection). According to the NHS, methotrexate treatment for ectopic pregnancy is successful in 90 per cent of cases (viii), though one in 10 women will still need further treatment (see Surgery, below). It can, however, cause side effects in around three quarters of cases, the most common of which is moderate abdominal pain. Women who receive methotrexate treatment for an ectopic pregnancy are also advised to wait for three months before trying to become pregnant again, and also not to drink alcohol until they’re told it’s safe to do so.
Surgery If observation and medication haven’t been successful – or if you have a ruptured fallopian tube – you will need surgery for an ectopic pregnancy. In most cases a laparoscopy (keyhole surgery) is suitable, where the ectopic pregnancy is removed through small incisions in your abdomen before it gets too big (that is, before it’s at risk of rupturing). In the case of a tubal pregnancy, if your other fallopian tube looks healthy, the operation will remove the entire affected fallopian tube along with the ectopic pregnancy – this is the most effective treatment and you should still be able to get pregnant again. You should also be able to leave hospital after a few days, but it usually takes up to four to six weeks to recovery completely from the operation.
Women who already only have one fallopian tube – or their other fallopian tube doesn’t look healthy – may be advised to have a different surgical procedure called a salpingotomy. This aims to remove the ectopic pregnancy but leave the fallopian tube in place. It will usually mean you can still get pregnant in the future, but your risk of having another ectopic pregnancy will be higher than normal.
If your fallopian tube has already ruptured you’ll need an emergency procedure called a laparotomy – this is a type of open surgery, where a larger cut is made in your abdomen. This makes it easier and quicker for a surgeon to stop the bleeding and – if possible – repair your fallopian tube. Normally, however, it takes more time to recover from open surgery than keyhole surgery, which means you’ll probably have to stay longer in hospital.
Ectopic pregnancies that develop in other parts of the body may need surgery too. For instance, in cases of ovarian ectopic pregnancy, surgery may remove the affected ovary as well as the ectopic pregnancy (the operation in this case is called an oophorectomy). Some, however, may resolve by themselves naturally (including cervical ectopic pregnancies) while others can be treated with methotrexate injections.
How to cope after an ectopic pregnancy
Many women need emotional support after having an ectopic pregnancy. Not only is there the shock, grief and sadness that comes with losing a pregnancy, but some may also feel anxious or depressed about having another ectopic pregnancy in the future or the effect it may have had on their fertility. If you have any worries at all, or if you’re struggling to come to terms with the loss of a pregnancy, talk to your GP about counselling. You could also try joining a support group for people affected by losing a pregnancy. Some of the organisations that offer support include:
Ectopic Pregnancy Trust
Miscarriage Association
Cruse Bereavement Support
Ectopic Pregnancy Foundation
Taking care of your physical health after an ectopic pregnancy can also have a positive effect on your mental wellbeing, so try to eat as healthily as possible, stay active by doing some gentle exercise and try to sleep as well as you can. You may want to give yourself some extra nutritional support by taking a multivitamin and mineral supplement to ensure you’re getting all the nutrients your body needs, plus a high-strength fish oil supplement to give your overall health a boost too.
Most importantly, try to remember that most women who have ectopic pregnancies go on to have healthy pregnancies afterwards, including those who’ve have had a fallopian tube removed. Finally the NHS claims that while you can’t always prevent an ectopic pregnancy, you can reduce your risk by using a condom to protect against STIs when you’re not trying to get pregnant, and by giving up smoking if you smoke.
Need more info?
There’s more information about pregnancy in our pregnancy guide, as well as lots of articles on women’s health in the women’s health section of our pharmacy health library.
References:
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Available online: https://www.nhs.uk/conditions/ectopic-pregnancy/.
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Available online: https://ectopic.org.uk/what-is-an-ectopic-pregnancy.
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Available online: https://www.ectopicpregnancy.co.uk/for-patients/sites-of-eptopic-pregnancy/.
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Available online: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/ectopic-pregnancy-patient-information/.
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Available online: https://patient.info/doctor/ectopic-pregnancy-pro.
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Available online: https://www.nhs.uk/conditions/ectopic-pregnancy/symptoms/.
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Available online: https://ectopic.org.uk/reasons-for-an-ectopic-pregnancy.
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Available online: https://www.wwl.nhs.uk/media/.leaflets/6135f0ad8887c0.67252040.pdf.
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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.
Christine
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.
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