Ectopic Pregnancy

The statistics for ectopic pregnancy are 1 in 250 pregnancies (miscarriages are 1 in 4) so ectopic pregnancies are often overlooked or lumped in with miscarriage, mainly because the end result is an early pregnancy loss. Although we too have included them, we do understand that there are differences both physically and emotionally. In miscarriage the baby loss outcome is inevitable as the baby has usually already died, depending on the cause, and the miscarriage is triggered by the body itself.

With ectopic pregnancies, the baby is still alive although it will eventually die. A conscious decision made by medical professionals to remove the baby usually with the tube it is stuck in.  There is no choice as the mother’s life is threatened as well.  The resulting trauma from that for the woman is so much more intense. (see Sally’s story under resources, personal memories)

Ectopic pregnancy dangers

If you are reading this it is most likely after an ectopic pregnancy, as things would have happened very quickly. If not, and the symptoms below apply to you – please get help immediately. You are in a dangerous situation. This pregnancy is growing outside of the uterus, where the normal fertilised egg is most commonly stuck in the fallopian tube and cannot survive. It also puts you, the mother, at risk as the baby continues to develop until it eventually ruptures the tube. This pregnancy will have to be terminated immediately to save your life.

The symptoms are:

• Sharp, intense pains that do not feel like period pains and could also be felt in your shoulder
• A pregnancy test that is positive, then turns negative a few days later
• Dark bleeding like prune juice that continues and can be spotty, starting after the pain
• Faintness, nausea, dizziness and vomiting.

Why ectopics happen

• Sometimes the fertilised egg is very slow travelling along your fallopian tube to your womb. This gives your embryo more time than usual to grow and it becomes stuck so implants itself where it is.
• Some women have slightly narrow tubes. This can be from scarring caused by previous surgery and/or infections. The latter maybe due to current or past sexually transmitted diseases.
• Sometimes scarring is also caused by the prolonged use of Intrauterine Contraceptive devices.

Ectopic Diagnosis

For an ectopic diagnosis, the medical professional may check your Hcg levels, which could be lower than in a normal pregnancy and also ask about your past and perhaps family medical/pregnancy history. For confirmation of an ectopic, an ultrasound check around your pelvic area is usually done. This requires a full bladder. Sometimes a vaginal scan is required as well and you will need to be examined internally. A decision will then be made to remove the embryo and end the pregnancy. (If you have a choice it is a good idea to have nothing to eat or drink before a diagnosis is confirmed.)

What is happening is that a fertilised egg is growing outside of the uterus or womb, which is where the egg normally grows, and is a ‘tubal pregnancy’. It is most commonly stuck in the fallopian tube, and cannot survive there. There are medical options available depending on the egg and country you are in. If the ectopic pregnancy has not already burst, treatment with a medication called Methotrexate could be used to help absorb the pregnancy. Mostly however an operation is needed. This will require being admitted to hospital.

Removing the egg

You will be given a general anaesthetic and using an instrument called a Laparoscope the Surgeon will look inside your stomach through a small incision in your navel. Once the Surgeon sees where the egg is located, he/she will remove it and when necessary the tube also. With small ectopic pregnancies, it is possible to cut the tube and carefully remove the egg and save the tube using the Laparoscope. It is also means a smaller cut and less recovery time requiring an overnight or a few days hospital stay. It may be necessary to make a larger cut along the lower part of your stomach by laporotomy (cutting through your abdominal wall) requiring more recovery time and perhaps longer in hospital.

Once home you will still need to take it easy for an average of about a week before returning to work or normal life. Surgeons normally try very hard to leave your fallopian tubes intact, but if the pregnancy has left the tube badly damaged, it will need removing. When this happens, you will not be able to conceive when you ovulate on this side (the other side is unaffected) without fertility treatment. Follow-up check-ups are a must to make sure everything is healed and no infection is present.

If the egg is not removed, the tube will eventually rupture and haemorrhage as the baby continues to develop. This puts you, the mother, at risk. These are guidelines only, every case is different and there are also several risk factors around ectopic pregnancy even if treated. There could be another ectopic and it can also affect future fertility including pelvic inflammatory disease. Suggestions are usually offered for the future hospital staff. For more medical information visit www.obgyn.net (09.09)

Additional help

However, it is most likely that you are reading this entry because you are looking for help. Unfortunately, we do not have any support information other than our ‘grief’ section. A counsellor specialising in grief therapy may be more useful or ladies on our Facebook who may have also had ectopics. Only women who have had a similar experience will really relate to you and we do not currently have any direct connections. (The one lady in the opening paragraph (Sally’s Story) who was kind enough to write her personal story for us was some time ago.) For support or a forum visit ectopicpregnancyfoundation.org (09.09)