Ectopic pregnancy: the facts

Ectopic pregnancy is a complication of pregnancy in which the fertilised egg is implanted in tissue other than the uterine wall, such as the cervix, fallopian tubes or ovaries.

If you think you could possibly be pregnant and experience one or more of the following symptoms, you should see your doctor as soon as possible, as they can be considered a sign of ectopic pregnancy. Left untreated, it can be very dangerous and even fatal. 

Pregnancy tests

These may be positive, but not always - in some cases, home pregnancy tests (HPTs) will show up as negative for a few weeks or appear to be faint when you have an ectopic pregnancy. Repeated use of sensitive blood pregnancy tests can help tell doctors how the pregnancy is going on even if your urine pregnancy test isn't positive or has stopped being positive. Beta HCG levels double during a normal pregnancy, and failure to do so indicates there is something wrong.

Many HPTs claim they can tell if you're pregnant on the day you expect your period, but a recent study shows that most don't give accurate results this early in pregnancy. Waiting one week after a missed period will usually give a more accurate answer.

Lower abdominal or pelvic pain

You might feel cramping pain with tenderness, usually in the lower abdomen - on one side initially, though the pain can radiate throughout the abdomen, and can feel similar to having a stitch. In some cases woman have describe only having mild niggling twinges, having pain that radiates from the hip down the leg, having a tummy ache and feeling pressure in the bottom. Pain may worsen on straining of bowels (feeling of constipation), coughing or moving.

If a tubal rupture occurs, pain becomes very sharp and steady for a short time before diffusing throughout the pelvic region. Many feel they're having a miscarriage, but this may not be the case.

If you feel pain when you have your bowels open or when you pass urine, and you think you may be pregnant, you should mention this when you go for a check-up.


Abnormal bleeding

Bleeding doesn't completely rule out an ectopic pregnancy. Vaginal bleeding is the first symptom in 20 per cent of ectopic pregnancies. Vaginal bleeding has been described as brownish, pink-tinged or bright red spotting, while some say it looks similar to prune juice (slight, dark and watery). In other cases bleeding is heavy - this is usually because the tube has ruptured.

Though there can be many other reasons for vaginal bleeding in pregnancy, it should not be ignored. Blood tests should be taken, so you should contact your GP, OB or local emergency department.

Nausea and faintness

Nausea and vomiting occurs in 25 to 50 per cent of ectopic pregnancies, but this may be hard to distinguish from morning sickness. If there's a tubal rupture you may experience weakness, dizziness, and a sense of passing out upon standing - these can all represent internal bleeding.

Other signs include paleness (clammy skin), increasing pulse rate, diarrhoea and falling blood pressure.

Shoulder pain

This can occur due to internal bleeding, irritating the diaphragm when you breathe in and out. Pain might be felt around the tips of the shoulders and running up the neck. If it is accompanied with any of the above symptoms, see your doctor immediately.

Who's at risk?

In most cases, there may be no apparent reason an ectopic pregnancy has occurred, and there is nothing that could have been done differently to prevent it.

There have been links to the following:

  • Many cases are a result of scarring caused by a past infection in the Fallopian tubes, surgery of the Fallopian tubes, or a previous ectopic pregnancy. Up to 50 per cent of women who have ectopic pregnancies have had inflammation of the Fallopian tubes (salpingitis) or pelvic inflammatory disease.
  • Some ectopic pregnancies can be due to birth defects of the Fallopian tubes, endometriosis, complications of a ruptured appendix, or scarring caused by previous pelvic surgery.
  • Sometimes, a woman will become pregnant after having her tubes tied. Women who have had successful surgery to reverse tubal sterilisation in order to become pregnant also have an increased risk of ectopic pregnancy.
  • Taking hormones, specifically oestrogen and progesterone (such as those in birth control pills), can slow the normal movement of the fertilised egg through the tubes and lead to ectopic pregnancy.
  • Women who have in vitro fertilisation or who have an intrauterine device (IUD) using progesterone also have an increased risk of ectopic pregnancy.
  • The morning after pill (emergency contraception) has been linked to some cases of ectopic pregnancy.

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