Ectopic pregnancy occurs when a pregnancy has implanted outside of the womb. It can be in the fallopian tubes (commonest), ovaries, cervix and other locations in the abdomen. A pregnancy is meant to grow in the womb, which grows together to accommodate a growing baby. But if left to grow at other locations, it can be very dangerous.
The incidence of ectopic pregnancy is about 1 in every 100 pregnancies. It is not very common but if it has occurred in the past, your risk increases to 1 in 10 for your future pregnancies.
What symptoms would I have?
The commonest symptoms reported in ectopic pregnancies is pain. Other symptoms include:
· Abdominal cramps
· Vaginal bleeding
· Sudden severe pain in the abdomen (possibly indicating a ruptured tube)
Some women do not have any symptoms at all, and it is only picked up when they have their dating ultrasound.
What are the risk factors for an ectopic pregnancy?
An ectopic pregnancy commonly occurs when the fertilised egg is unable to make its way to the womb to be implanted. This is usually due to scarring in the tubes, preventing a smooth passage. Conditions that can contribute to this include:
· History of endometriosis
· History of pelvic infections or sexually transmitted infections
· Previous abdominal surgery
· History of tubal sterilisation reversal
· Assisted reproduction pregnancy
· History of ectopic pregnancies
What do I do if I have an ectopic pregnancy?
The first thing that you need to do is to see a doctor and sometimes, the ultrasound place might refer you directly to the hospital emergency.
It is important to be seen by a doctor as there is a risk of the pregnancy bleeding internally. You will need to be seen and treated accordingly. This may be in the form of more tests, or an observation in hospital. Management options would be discussed with you by your healthcare provider.
What are the management options?
There are generally 3 management options.
This is where we mainly monitor your pregnancy and wellbeing. In a very small percentage of women, the pregnancy hormone may be very low and is declining. If the women is not symptomatic, this may be an option but this needs to be very carefully assessed and discussed with your doctor. It is not a common management option for most cases.
A medication called methotrexate may be recommended if the pregnancy hormones are not overly high, and if the pregnancy size is small. It is a medication that is more commonly used in treatment for cancer, but in cancer it is given as a repeated dose over weeks or longer. In ectopic pregnancies, it is usually only given once or twice via an intramuscular injection. It works by inhibiting the rapid growth of pregnancy cells.
Prior to methotrexate being administered, your doctor will have to discuss the risk and benefits of the medication and you will need to have a blood test. After the medication has been given, you would still be required to attend close follow up, usually with blood tests every week or so, until the pregnancy hormone returns to negative.
Methotrexate has a success rate of up to 85%. In event that methotrexate has failed, your doctor might recommend surgery.
There are some side effects that can be associated with methotrexate and they include
· Nausea +/- vomiting
· Abdominal cramping
· Some women might experience discomfort in their throats, hair loss, sensitivity to light and mouth/lung/liver inflammations but this is uncommon.
Sometimes, the ectopic pregnancy has ruptured and there is internal bleeding. In those cases, surgery is recommended. It is usually performed as a keyhole procedure.
In events where the pregnancy hormones are high, or the pregnancy size is large, surgery would also be recommended due to the increased risk of rupture. In the past, ruptured ectopic pregnancy used to be a common cause for death in young women due to the internal bleeding.
The risk with surgery for ectopic pregnancy are generally bleeding, infection, anaesthetic risk, bowel/bladder/ureter injuries due to surgery, and clots.
It is usually performed laparoscopically (keyhole) and you would be asleep during the procedure (General Anaesthetic). During the surgery, an assessment would be made to see where the pregnancy is located and a removal of the ectopic would be performed. This would usually be the removal of one fallopian tube, where the pregnancy had implanted. It is important to know that even if one of the tubes are removed, your fertility rates has not halved.
Your body is very clever, and most people would not have trouble falling pregnant if they have another healthy fallopian tube.
If you have had an ectopic pregnancy, it is important to discuss with your doctor when is it safe to have a next pregnancy, especially if you have had methotrexate treatment.
Due to the increased risk of having another ectopic pregnancy, make sure you have early blood tests and ultrasound to check on your future pregnancies.
Dr Adeline Chan is a specialist obstetrician and gynaecologist in Sydney, serving the Western Sydney and Hills District area.