Ectopic pregnancy: the signs and symptoms

"An ectopic pregnancy can be a leading cause of death in the 1st trimester of pregnancy if it isn’t diagnosed and treated quickly," says Munira Oza of the Ectopic Pregnancy Trust. "It is important for women to know the symptoms so that they are able to seek and get the care they need as fast as possible."

What are the main signs of ectopic pregnancy?

Some women don't have any symptoms, in which case their ectopic pregnancy is only picked up during a routine ultrasound scan.

But if you do have symptoms, they tend to develop between weeks 4 and 12 of your pregnancy, and commonly include:

• Pain in your abdomen or back. Some cramping is normal in early pregnancy but, if you have constant, acute pain low down and on 1 side (even if it comes and goes), it may be a sign that you have an ectopic pregnancy in 1 of your Fallopian tubes (the tubes leading from your ovaries to your womb) and that the tube is being stretched and damaged.
• Pain on the very tip of your shoulder. We know this sounds odd, but a very specific shoulder-tip pain (just where your shoulder ends and your arm begins) can be a sign of ectopic pregnancy (thought to be caused by internal bleeding). KTDaisy on our MadeForMums forum, who had an ectopic pregnancy, describes this shoulder pain as "quite acute and constant – you notice it as it seems to be in a strange place, literally just on top of your shoulders."
• Vaginal bleeding. This occurs in 75% of ectopic pregnancies, and typically starts after the abdominal pain. It's often starts and stops, and looks watery and dark brown.
• Pain or discomfort when going to the toilet. This applies to weeing, as well as pooing. You may also have diarrhoea.

"Some of these symptoms are easily mistaken for something else," says Ruth Bender Atik of the Miscarriage Association, "like a stomach upset, irritable bowel syndrome or even appendicitis."

But you should contact your GP or call NHS 111 if you have a combination of any of these symptoms and you know you're pregnant – or think it's possible that you could be.

If you suddenly feel any of the following symptoms as well, you should call 999 or go straight to your nearest A&E:

• Sharp, intense pain in your tummy
• Feeling sick or nauseous
• Feeling very light-headed, dizzy or faint
• Looking very pale

What will doctors do if I have ectopic pregnancy symptoms?

It can be tricky for doctors to diagnose an ectopic pregnancy. But, unless you're very unwell indeed (in which case, you'll probably need treatment in A&E), it's likely that you'll be sent to an early pregnancy unit for an ultrasound scan.

The scan will probably be a transvaginal one, which means it involves a small probe that's inserted into your vagina (which may be uncomfortable but shouldn't be painful). The sonographer will look at images of your uterus (womb) and your Fallopian tubes for signs of a fertilised egg.

If nothing is found (ectopic pregnancies can sometimes be hard to spot), doctors may want to do some blood tests to measure your levels of the pregnancy hormone humanchorionic gonadotropin (hCG). These blood tests are often done twice, 48 hours apart, to track how the levels are changing over time (levels of hCG tend to be lower and slower to rise over time in an ectopic pregnancy).

If doctors still can't confirm an ectopic pregnancy – or if they can't find it in your Fallopian tubes – they may want to make a small cut in your abdomen (you'll be given general anaesthetic) and insert a laparoscope, a very thin tube with a camera, to look around the inside you more closely. If they find anything during this procedure, they're likely to remove it, so that you don't have to go through another procedure later.

How is ectopic pregnancy treated?

Unfortunately, it’s essential to remove your embryo because it is almost impossible to take it to term outside your womb and trying to do would damage you, possibly fatally. It can’t be moved into your womb, either.

If you're very unwell indeed, and your doctors think your Fallopian tube may have ruptured, you will need emergency surgery to stop the internal bleeding. It's possible that the surgeons may need to removed your damaged Fallopian tube, either completely or partially.

If it’s still very early in your pregnancy, and you have had only very mild symptoms, you may be advised to wait, under observation, to see if the pregnancy ends (and you miscarry) without any other intervention.

If this doesn’t happen or waiting under observation isn't felt to be appropriate for you, it may be possible to give you a medication called methotextrate. This is usually given by an injection into your buttock muscles. The drug stops the pregnancy developing any further and you body will gradually reabsorb the tissue, leaving your affected Fallopian tube intact.

In many cases, though, keyhole surgery is recommended – to protect your health. Your surgeon will make some small cuts in your abdomen (you'll be given general anaesthetic) and insert a laparoscope, a very thin tube with a camera and other small surgical instrument. Then they will remove the pregnancy tissue and, if your other Fallopian tube is healthy, the affected Fallopian tube. If there is an issue with your other Fallopian tube, the surgeon will try to remove the pregnancy tissue and leave the affected tube intact.

You should be able to go home in a few days, though you may need 4 to 6 weeks to recover completely. Removing a Fallopian tube shouldn't affect your ability to become pregnant again.

What causes ectopic pregnancy?

Ectopic is actually surprisingly common. In the UK, about 1 in 90 pregnancies are ectopic, and in some other countries the rate is higher.

It all starts about 4 to 5 days after conception, when your fertilised egg is ready to implant. Usually, your egg will have finished its journey down your Fallopian tube and be in the right position for implantation in your womb.

Sometimes, however, the egg is still in your Fallopian tube (or even somewhere else) when it is time for implantation. If it continues to develop, it will stretch and damage the tissues around it, causing internal bleeding and pain, threatening your health and, if left long enough, your life.

Scientists have found that you are more likely to have an ectopic pregnancy if you:

• have damage to your Fallopian tubes caused by pelvic inflammatory disease (PID). This means that the tube can’t move the egg along properly. The most common cause of PID is a sexually transmitted infection like chlamydia or gonorrhoea
• had an ectopic pregnancy before (though you aren’t at more risk if you have had another type of miscarriage)
• had a previous abdominal surgery or surgery to the Fallopian tubes (including surgery to treat a previous ectopic pregnancy)
• have had endometriosis, a condition where the womb lining grows outside the womb
• smoke, because this produces a particular protein in the Fallopian tubes which can hinder the progress of a fertilised egg
• became pregnant while using intrauterine contraceptive device (IUD), because IUDs are not as effective at preventing a pregnancy outside the uterus
• became pregnant while using the mini-pill, because this also alters the ‘motility’ of the Fallopian tubes
• have had IVF, because the embryo can travel into the Fallopian tubes during transfer
• are over 40 years old

But often, there isn’t an obvious reason why an ectopic pregnancy happens.

"It is important to remember," says Munira, "that an ectopic pregnancy cannot be prevented and, whatever caused it, it is not your fault."

If I had an ectopic pregnancy, will it happen again?

The chances of your having another ectopic pregnancy are higher than if you'd never had one – but the risk is still small (the NHS calculates it at 10%).

And even if you have lost a Fallopian tube, you should still have a good chance of becoming pregnant again, and carrying that baby to term, says Munira at the Ectopic Pregnancy Trust..

"Statistically, the chances of having a future successful pregnancy are very good and 65% of women are healthily pregnant within 18 months of an ectopic pregnancy," she says. "Some studies suggest this figure rises to around 85% over 2 years."

Obviously, it is very important that you tell your doctor as soon as you think you may be pregnant again, so that you can benefit from early screening this time around, as Poppygirl1 on our forum, did:

"I had an ectopic and lost my left tube. I found out that I was pregnant [4 months later] and I was petrified that it would all go wrong again.
I got an early scan at what I thought was 7 weeks.

"They did the ultrasound and couldn't see anything, so they had to do an internal scan, where they spotted a little flicker of a heartbeat beating away. It turned out that I wasn't as far gone as I though! I'm now 14 weeks pregnant, and my 12-week scan was perfect."

Where can I turn for support after ectopic pregnancy?

The Ectopic Pregnancy Trust offers a wealth of information and support, and so does the Miscarriage Association.

And of course you'll get lots of sympathetic ears here on our forum.

Read more...

• Mum's honest video about her ectopic pregnancy - 'I didn't realise how serious it was'
• How long does your body recover after miscarriage?
• The Miscarriage Association: how it can help