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Q: What is an Ectopic Pregnancy?
In normal pregnancy, after the egg has been released from the ovary and fertilized, it travels down the fallopian tube and into the womb (uterus) where it attaches to the lining and continues to develop. In an ectopic pregnancy, the fertilized egg implants outside the womb (usually in the fallopian tube) and continues to grow and enlarge. The fallopian tube is not designed to support a pregnancy and so as the pregnancy grows, the tube is stretched and eventually will rupture. On rare occasions the egg may implant elsewhere, in the ovaries, the cervix or abdomen.
Q: What are the causes of Ectopic Pregnancy?
Ectopic pregnancy occurs in about 1 in 100 pregnancies. The fertilized egg normally spends 4-5 days travelling down the fallopian tube to the womb where it implants. The most common reason for an ectopic pregnancy is damage to the fallopian tube resulting in a blockage or narrowing which may delay the passage of the fertilized egg allowing it to implant in the tube. Previous pelvic surgery, previous ectopic pregnancy and pelvic infection are the most common conditions that predispose an ectopic pregnancy however in most cases the cause is unknown.
Q: What are the signs and symptoms?
Any sexually active woman of child bearing age who has a positive pregnancy test and lower abdominal pain might be suspected of having an ectopic pregnancy until proved otherwise. Most cases present between the 4th and 10th week of pregnancy. Symptoms include abnormal vaginal bleeding including missed or late period, abdominal pain (sometimes persistent and severe and often on one side but not always), shoulder tip pain, pain when having bowels open, light headedness, pale, nauseous or faint and in the most extreme cases collapse.
Q: How is it diagnosed and treated?
Ectopic pregnancies are sometimes difficult to diagnose. Firstly we will do a urine pregnancy test and if it is positive you will have a scan of your pelvis. This usually will be an internal scan. If we cannot confirm a pregnancy in your womb then blood samples will have to be taken to measure your hormone levels. An ectopic pregnancy may be suspected when level don't rise appropriately. Sometimes we can see the ectopic pregnancy on the scan.
Confirmation of an ectopic pregnancy is usually by a Laparoscopy. This is a minor 'key-hole' surgical procedure where a telescope is passed through a small incision through your tummy button enabling the doctor to see the womb and fallopian tubes. Once it is proven that there is an ectopic pregnancy, surgery to remove it will be performed.
The best operation involves removing the tube affected by the pregnancy, as long as the other tube looks normal. If both tubes look damaged then we aim to just remove the pregnancy and leave the tube intact. Usually you can go home the day after the surgery, depending on your recovery. Occasionally, if the surgery is difficult or complicated an open operation or laparotomy may need to be performed. This is where an incision is made along the bikini line and it may mean a slightly longer stay in hospital.
Q: How soon can I return to normal activities and work?
The average stay in hospital following laparoscopic surgery is 1-2 days depending on your recovery. We would recommend that you take 2-3 weeks off work and gradually resume your normal activities. Before you leave the hospital, the nursing team will advise you about vaginal bleeding, wound care, infection and resuming sexual intercourse. If you have a laparotomy then your recovery time will be longer and the nursing and medical staff can advise you accordingly.
Q: How will this affect future pregnancies?
Before trying for another baby you should allow yourself time to recover both physically and emotionally. We usually advise you wait until you have your next normal period, but you may find that emotionally you need to wait longer.
If you have had an ectopic pregnancy you have a 10% greater risk of having further ectopics. If your fallopian tube has been removed and the other tube is normal there is still a good chance of conception taking place although it may take a little longer. The most recent research suggests that fertility is reduced by 20-25% (opposed to the expected 50%). This is why we remove the damaged tube, as leaving it behind does not improve your fertility significantly but it does increase your risks of further ectopic pregnancies.
If you have had an ectopic pregnancy you should consult your doctor as soon as you suspect you are pregnant. Early monitoring of the pregnancy is important so that another ectopic pregnancy can be excluded. We are happy to see you for a scan at about 7 weeks in the early pregnancy clinic.
Q: How will it affect me emotionally?
Ectopic pregnancy can be a very traumatic and painful experience. It is likely you would have been rushed to the operating theatre with very little time for psychological adjustment. Much of what has happened to you will have been out of your control, maybe leaving you in a state of shock. You will be recovering from surgery; you and your partner will need to cope with the loss of your baby and often the loss of part of your fertility. Your feelings may vary enormously in the weeks and months following your loss. Listed below are some useful contacts that may help in you and your partner's recovery.
Royal Sussex County Hospital
01273 664402 (EPAC: Monday-Friday 8-12)
01273 696955 Ext. 4013 ( Jowers Ward)
Brighton General Hospital
Day Case Unit E1
01273 696955 Ext. 5215
Sally Meyer & Marion Anderson
Women and Children Directorate Counselling Service
01273 381210
Peter Wells
Hospital Chaplain
01273 696955 x 7495
The Ectopic Pregnancy Trust, Maternity Unit, The Hillingdon Hospital,
Pield Heath Road, Uxbridge, Middlesex, UB8 3NN. Phone: 01895 238 025.
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