Ectopic pregnancy

An ectopic pregnancy occurs when a fertilised egg attaches itself somewhere outside the uterus.

In a normal pregnancy, an egg is fertilised by a sperm in one of the two fallopian tubes which connect the ovaries to the uterus. The fertilised egg is ‘wafted’ along through the fallopian tube by tiny hairs into the uterus and implants itself into the wall of the uterus, where it grows and develops into the embryo and placenta. In an ectopic pregnancy this process breaks down and the fertilised egg attaches itself somewhere else.

About 1 in 100 UK pregnancies are ectopic pregnancies. The huge majority of cases, over 95%, occur in a fallopian tube. This is known as a tubal pregnancy. Ectopic pregnancies can also occur in an ovary, in the abdominal space, or in the cervix (neck of the uterus) but this is rare.

An ectopic pregnancy can be life-threatening if not treated quickly..

If you have, or someone you know has, suffered an ectopic pregnancy, and would like additional support, please visit our In Memory section.

Risk factors for ectopic pregnancy

Your are more likely to have an ectopic pregnancy if:

you are using a contraceptive coil (IUD, intra-uterine device,
you have had previous surgery or damage to the fallopian tubes,
you have had pelvic inflammatory disease, which leads to the tiny hairs (cilia) being unable to transport the egg to the correct place for implantation,
you have had a previous ectopic pregnancy,
you have become pregnant by IVF. Despite the fertilised egg being placed in the uterus, there is a risk it may attach itself elsewhere,
you smoke.

Signs and symptoms of an ectopic pregnancy

If you are pregnant, the following are the signs that it could be an ectopic pregnancy:

vaginal bleeding which looks dark and watery,
pain on one side of your abdomen which can be persistent and severe,
sudden severe pain spreading across your abdomen,
shoulder tip pain,
fainting, increased pulse rate, sickness and paleness.

Treatment of an ectopic pregnancy

If an ectopic pregnancy is suspected an ultrasound scan will be carried out alongside a pregnancy test. If the scan shows that the uterus is empty and the pregnancy test is positive then this suggests an ectopic pregnancy, although a recent miscarriage would give the same results. Sometimes the ectopic pregnancy can be seen on the scan.

If diagnosed early it may be possible to remove the ectopic pregnancy before the fallopian tube ruptures, and leave the tube intact.

Sometimes abdominal surgery is needed to remove the ectopic, particularly if the tube is ruptured and a blood transfusion needed to replace lost blood. Alternatively, the drug methotrexate can be used which shrinks the pregnancy cells and eventually the ectopic disappears. Success rates using this type of treatment are slightly lower than surgery.

Effects on future pregnancies

The outlook for future pregnancies depends on various factors, including the health of the remaining fallopian tube or tubes.

The overall chance of a repeat ectopic pregnancy is 7-10%, depending on the type of surgery undertaken. If the second tube is damaged then there is a 30% chance of being unable to conceive, plus an increased risk of another ectopic. If a fallopian tube is removed a woman will continue to ovulate, but her chances of conceiving are reduced by 30%, as an egg produced on the tubeless side may manage to descend the remaining tube around 15% or 20% of the time, and find its way into the uterus (womb).

If the contraceptive coil was the cause of the ectopic pregnancy there seems to be no increase in risk of another ectopic if the device is removed.

Before trying for another baby it is important to allow time to heal physically and emotionally. Ectopic pregnancy can be a difficult experience for you and your partner. It might have been a frightening time. You may have had extensive surgery, you will have lost your baby and your fertility may be reduced. Although the thought of having another ectopic pregnancy might make you anxious this does not mean that you cannot go on to have a normal pregnancy in the future.

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