Ectopic pregnancy

Overview

An ectopic pregnancy or extrauterine pregnancy (EUP) occurs when a fertilised egg implants itself and grows outside the womb. Causes may include, for example, inflammation in the abdominal cavity or a problem with the fallopian tubes. Vaginal bleeding between periods and dull or throbbing pain on one side of the lower abdomen are suspicious.

Symptoms

• Missed/late period
• An ectopic pregnancy often goes unnoticed until it leads to a miscarriage
• Dull or throbbing pain on one side of the lower abdomen
• Sometimes spotting
  • Misinterpreted as a late period
  • Usually six to eight weeks after the missed period
  • If bleeding continues too long, risk of anaemia
  • Indicates lack of pregnancy growth (known as withdrawal bleeding)

Most severe progression: tubal rupture

• Tearing or bursting of a “pregnant fallopian tube”
  • Sudden onset of acute lower abdominal pain
  • Bleeding into abdominal cavity (possibly severe bleeding which can be life-threatening in extreme cases)
• Risk of a haemorrhagic shock
  • Massive blood loss
  • Danger of bleeding to death
  • Pale, cold and clammy skin
  • Highly elevated pulse rate
  • Often, nausea and vomiting
  • Loss of consciousness

Consequences

• Increased risk of another ectopic pregnancy
• Infertility (sterility) if the cause can't be eliminated (e.g. repairing of fallopian tube or removal of adhesions)

Causes and treatment

• Pregnancy in the “wrong” location
  • Fertilised egg doesn’t make it to the womb
  • Attaches and starts to develop in a fallopian tube, ovary, somewhere in the abdominal cavity (abdominal pregnancy) or cervix

Causes

• Obstacles preventing passage through the fallopian tube: scars and adhesions in or in the vicinity of a fallopian tube
  • After infections: adnexitis or peritonitis
  • After wearing a coil (intrauterine device) for a long time
  • After fallopian tube surgery or repeated abortions
  • Mucosal polyps or endometriosis lesions (Endometriosis)
• Previous ectopic pregnancy: risk of another extrauterine pregnancy is around 10%
• Fallopian tube dysfunction: fertilised egg isn’t transported to the womb
• Hormone treatment for infertility
• Risk increases as women grow older

Further treatment by your doctor / in hospital

Possible tests

• Abdominal examination
• Blood and urine tests, incl. pregnancy test
• Vaginal ultrasound

Possible therapies

• Pregnancy can't be saved
• Medicinal termination of pregnancy without surgery (if correctly diagnosed at a very early stage)
• Operation: usually diagnostic and therapeutic laparoscopy (“keyhole surgery”)
  • Pelvic laparoscopy to confirm diagnosis and remove the fertilised egg and fallopian tube
  • If possible, function-preserving operation for patients who still want children
  • For haemorrhagic shock: emergency abdominal incision to stop the bleeding

What can I do myself?

• Can’t be influenced arbitrarily
• Warm stomach poultices and bed rest for abdominal pain
• Don't delay going to the doctor if an ectopic pregnancy is suspected
• Indirect prevention by avoiding or obtaining early treatment for adnexitis
  • Follow the safer sex rules: always use a condom or femidom during sexual intercourse, don't get sperm or blood (including menstrual blood) in your mouth, and don’t swallow

When to see a doctor?

• Vaginal bleeding between periods
• Unexplained abdominal pain
• Emergency: sudden onset of severe abdominal pain, combined with vaginal bleeding
• Generally for a routine examination if pregnancy is suspected
  • An extrauterine pregnancy can be detected by ultrasound from the sixth week of pregnancy

Synonyms

ectopic pregnancy, tubal pregnancy, abdominal pregnancy, EUP, extrauterine pregnancy