What is ectopic pregnancy?
For pregnancy to occur a mature egg must be fertilised by sperm and implant in the lining of the uterus (womb).
During each menstrual cycle, a mature egg is released from one of the ovaries (this is called ovulation). The released egg is funnelled into the fallopian tube where it may meet and combine with sperm (this is called fertilisation). Fertilisation usually occurs in the fallopian tube. Once fertilised, the combined egg and sperm (embryo) move down the fallopian tube and into the uterus (womb) to implant in the uterine lining (endometrium) and pregnancy occurs.
An ectopic pregnancy occurs when the fertilised egg and sperm implant in a place outside the uterus (womb). This is usually in one of the fallopian tubes and in rare cases, in the cervix (entrance to the womb), abdominal cavity or ovary.
Unlike the uterus, the fallopian tube is unable to stretch and grow with pregnancy and does not have the blood supply to support the growing embryo. An ectopic pregnancy cannot continue. Around 1 – 2 in 100 pregnancies are ectopic.
If not diagnosed early an ectopic pregnancy can cause the fallopian tube to burst.
Why does ectopic pregnancy happen?
While ectopic pregnancy is thought to occur due to damage, scarring or a blockage of the fallopian tube, the cause is often unknown. Around 50% of those who have an ectopic pregnancy have no known risk factors.
Factors that can increase the risk of ectopic pregnancy include:
- Past pelvic inflammatory disease (PID).
- Tubal ligation (sterilisation) procedure or reversal.
- Previous ectopic pregnancy.
- Scarring from pelvic surgery.
- Having a fallopian tube that is not the usual shape.
- Use of assisted reproductive technologies such as in vitro fertilization (IVF).
- Being over the age of 35 years.
Contraception and ectopic pregnancy
The use of IUDs decreases the overall risk of ectopic pregnancy. However, if a person does become pregnant when using a hormonal IUD (Mirena or Kyleena) there is around a 50% chance the pregnancy will be ectopic. The risk is around 15% if the person is using a copper IUD.
If a pregnancy occurs when using an IUD, an ultrasound should be performed to check the location and stage (length) of the pregnancy.
There is also a small increase in the risk of a pregnancy being ectopic if the person is using the progestogen only pill. There may also be a small increase in the extremely rare case that a person becomes pregnant while using the contraceptive implant.
All methods of contraception can be used by people who have had a past ectopic pregnancy.
How would I know if I have an ectopic pregnancy?
An ectopic pregnancy can first appear as a normal pregnancy with usual symptoms such as a missed menstrual period, morning sickness and breast tenderness.
Other early symptoms of ectopic pregnancy can include:
- Pain or cramps in the lower abdomen (usually on one side).
- Pain in the shoulder, neck, lower back and/or rectum.
- Light to heavy vaginal bleeding or spotting.
- Nausea and/or vomiting.
- Dizziness, weakness or fainting.
Sedation: a medicine used to cause a relaxed, sleep-like state so you are unaware of the procedure.
Diagnosis of ectopic pregnancy
If you have any symptoms of ectopic pregnancy, you should seek medical care as soon as possible. Your doctor, nurse or midwife usually takes a medical and sexual health history. You will have the opportunity to ask questions and be given any information you may need. What you discuss will be kept confidential.
The doctor or nurse will then explain what tests are recommended. In most cases ectopic pregnancy can be diagnosed by:
- urine and blood pregnancy tests
- a physical examination
Sometimes a laparoscopy may be required. This is when a small incision (opening) is made in the pelvic area (lower belly) and a small laparoscope (camera on a flexible tube) is inserted to view the fallopian tube. Laparoscopy is done under sedation.
Some cases of ectopic pregnancy are diagnosed in a hospital emergency clinic after the fallopian tube has ruptured.
How is ectopic pregnancy treated?
An ectopic pregnancy cannot continue as the embryo will not develop and it is unsafe for the pregnant person. Treatment for ectopic pregnancy depends on the location of the pregnancy in the body and the stage (length) of pregnancy.
Sometimes an ectopic pregnancy will shrink on its own and miscarry.
In other cases, if the fallopian tube has not ruptured and the pregnancy is early, an injection of a medication (methotrexate) can be used to stop the pregnancy from growing. After the injection, the pregnancy cells will be absorbed by the body.
Sometimes laparoscopic surgery is needed to view and remove the ectopic pregnancy and repair any damage to the fallopian tube. In some cases, the fallopian tube will need to be removed.
A ruptured fallopian tube is a medical emergency. In this case immediate laparoscopic surgery is required. Occasionally larger surgery and a blood transfusion are required.
Most people who have had an ectopic pregnancy can become pregnant again, but will need careful monitoring, as their risk of ectopic pregnancy is higher.
How can I lower my risk of ectopic pregnancy?
Many cases of ectopic pregnancy are caused by damage, scarring or blockage to the fallopian tubes. Ways to reduce this risk include:
- Lowering your risk of getting sexually transmissible infections (STIs) by using barrier protection (external condoms or internal condoms) correctly during any type of sex (vaginal, anal or oral sex) and when sharing sex toys.
- Both you and your sexual partner/s having regular STI and BBV testing.
- Treat any STI or pelvic infection promptly.
- Avoid smoking.
Early pregnancy health care
Although predicting and preventing ectopic pregnancy is not possible, prenatal (pregnancy) health care in early pregnancy considerably reduces the number of complications from ectopic pregnancy. If you think you may be pregnant, it is recommended you see a doctor or nurse as soon as possible.
People at high risk of ectopic pregnancy should be offered closer monitoring during early pregnancy. This may include additional clinic visits, blood tests and/or ultrasound tests.
It is important to tell your doctor, nurse or midwife if your medical history includes any of the known risk factors for ectopic pregnancy. You should also see your doctor nurse or midwife immediately if you have unusual pregnancy symptoms such as cramping, pain or vaginal bleeding.
Where to get more information, support or advice
- In an emergency, call triple zero (000) for an ambulance or go immediately to your nearest hospital emergency department
- Sexual Health Victoria
- A doctor or nurse
- Your local community health service
- A public hospital
- An obstetrician or gynaecologist
- Better Health Channel
- Multicultural Centre for Women’s Health
- The Women’s (The Royal Women’s Hospital)
- Young Women’s Health Program (support, pregnancy care and education for young pregnant and parenting women 19 years old and under)
If you are using the internet for information, only use reliable and reputable websites, such as the ones provided above.