Ectopic pregnancy
During ovulation, an egg (ovum) is released from one of the ovaries. Conception occurs when the egg is met by a sperm in the fallopian tube. Normally, the fertilised egg travels down the fallopian tube and into the uterus, where it buries into the plump uterine lining. Ectopic pregnancy refers to a pregnancy that develops outside of the uterus, most commonly in one of the fallopian tubes that leads from each ovary. In almost all cases, the embryo dies. The developing placenta can’t access a rich blood supply and the fallopian tube is not large enough to accommodate the growing embryo. In one out of five cases, the tube ruptures causing internal bleeding and shock. This is a medical emergency requiring immediate surgery and blood transfusion.
Other sites for an ectopic pregnancy include the cervix (neck of the uterus), the abdominal cavity and the ovary itself, although these sites are rare. Around half of one per cent of all pregnancies are ectopic.
Symptoms
The symptoms of ectopic pregnancy can mimic miscarriage or the symptoms of other gynaecological disorders, such as pelvic inflammatory disease (PID) and endometriosis. An ectopic pregnancy can initially appear as a normal pregnancy. The possible symptoms of ectopic pregnancy include:
- The usual signs of pregnancy, such as amenorrhoea (missed period), morning sickness and breast tenderness.
- Pain in the lower abdomen.
- Pain in the lower back.
- Cramps on one side of the pelvis.
- Vaginal bleeding or spotting.
- If the fallopian tube ruptures, rapid onset of severe pain in the lower abdomen.
Ectopic pregnancies are caused by the fertilised egg’s inability to move through the fallopian tube. This can be caused by a blockage in the tube, or the failure of the tiny hairs inside the tube to sweep the fertilised egg on its way. The factors that may increase a woman’s risk of having an ectopic pregnancy include:
- Prior tubal sterilisation, where the tubes are ‘tied’ as a permanent form of contraception.
- Successful reversal of a tubal sterilisation.
- Endometriosis.
- Previous infection with pelvic inflammatory disease (PID) or salpingitis (inflammation of the fallopian tubes), and subsequent scarring.
- Defects of the fallopian tube.
- Using assisted reproductive technologies.
- Prior ectopic pregnancy.
- Damage to the fallopian tube caused by ruptured appendix.
No contraceptives currently available in Australia increase the risk of ectopic pregnancy. IUDs and the progestogen-only pill (minipill) do not give as good protection against ectopic pregnancies as do other forms of contraception like the combined pill and may not be a good choice for women at higher risk of ectopic pregnancy. Women using these forms of contraception are warned to be aware of the symptoms of ectopic pregnancy.
Diagnosis methods
Around one in five ectopic pregnancies is diagnosed in the emergency room, after the fallopian tube has ruptured. In most cases, an ectopic pregnancy can be diagnosed using a range of tests, some of which are standard medical procedure for all pregnant women, including:
- Pelvic examination
- Blood tests
- Pregnancy ultrasound
- Transvaginal ultrasound
- Laparoscopy (‘keyhole’ surgery).
A ruptured fallopian tube is a medical emergency. Laparoscopic (‘keyhole’) surgery is performed to remove the embryo and attempts are made to repair the fallopian tube. A blood transfusion may also be necessary. About half of all women who undergo emergency surgery for ectopic pregnancy may experience difficulty conceiving in the future. For non-emergency ectopic pregnancies, treatment options may include medications and laparoscopic surgery to remove the embryo.
Early screening is vital
In the three years from 1988 to 1990, only two of the 96 maternal deaths in Australia were caused by ectopic pregnancy. Early screening and advances in prenatal testing have reduced the maternal mortality rate considerably. For example, a pregnancy ultrasound may reveal an empty uterus, which then prompts further tests (such as a transvaginal ultrasound or laparoscopic surgery) to discover the location of the embryo. However, only around half of all cases of ectopic pregnancy will be diagnosed through clinical methods. Closely monitoring those women who have known risk factors is therefore crucial. It is important to tell your doctor if your medical history includes any of the known risk factors. You should also see your doctor immediately if you experience unusual pregnancy symptoms, such as cramping, pain or vaginal bleeding.
Risk reduction
Most cases of ectopic pregnancy are caused by scarring of the fallopian tubes. Suggestions to reduce the risk of fallopian tube damage include:
- Treat any pelvic infection promptly.
- Treat any sexually transmitted disease promptly.
- Avoid sexually transmitted infections and infection by always using a condom during sex, if a risk of STI is at all possible.
- Your doctor
- Obstetrician.
- Ectopic pregnancy refers to a pregnancy that develops outside of the uterus, most commonly in one of the fallopian tubes.
- Symptoms include cramping, abdominal pain and vaginal bleeding.
- A ruptured fallopian tube is a medical emergency.
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Article publication date: 27/04/2001
Last reviewed: 30/06/2004
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