Ectopic Pregnancy

Dr. Hoggenmueller provides specialist care to women at an increased risk of ectopic pregnancy or with a heterotopic pregnancy. She consults in Melbourne, Bundoora and Heidelberg, and can be available 24 hours, 7 days a week for women with high-risk pregnancies.

Ectopic Pregnancy: Signs, Symptoms, Causes &
Treatments

Experiencing an ectopic pregnancy can be painful and distressing. There are many complex processes within your body that result in this condition, so it’s important to know its signs, symptoms and causes. If you do in fact have been diagnosed with an ectopic pregnancy, it’s also vital to know the various treatment options available to you. It’s important to receive expert advice from an Obstetrician & Gynaecologist before making any important decisions that affect your body.

What is an ectopic pregnancy?

An ectopic pregnancy occurs when an embryo grows outside of the uterus. The word ectopic means – “out of place”. Rather than attaching to the inside wall of the uterus, a fertilized egg remains within the fallopian tube or implants to the tissue of the ovary, cervix, or abdomen. The most common place for an ectopic pregnancy to grow is the tube – it is sometimes also called a tubal pregnancy or fallopian tube pregnancy. Unfortunately, all ectopic pregnancies result in the loss of that pregnancy. The body cannot sustain and nourish an embryo that is situated outside of the uterus. It is estimated that 1-2% of all pregnancies are
ectopic.
In some extremely rare cases, a heterotopic pregnancy occurs. Heterotopic pregnancy is one in which there are two embryos present – one of which is inside the uterus as it should be, and another which is ectopic and located outside of the uterus. This only affects 1:7000 -30.000 pregnancies, so it is much less common than a tubal ectopic pregnancy.

Causes of ectopic pregnancy.

An ectopic pregnancy is caused when an egg and sperm meet while the egg is still traveling along the fallopian tube to the womb. If fertilization occurs while the egg is near the ovary or in the fallopian tube, there is still a chance the egg will continue towards the womb and implant as it should. If it remains in the fallopian tube, an ectopic pregnancy occurs. The exact cause of an ectopic pregnancy is often unknown. However, there are some factors that can increase the chance of an ectopic pregnancy happening.

  • Being over 35 years of age – the highest likelihood of ectopic pregnancy occurs in women aged between 35 and 44 years.
  • Smoking – heavy smoking at the time of conception has been proven to increase risk.
  • Known infection to the reproductive organs – Pelvic Inflammatory Disorder (PID) is caused by sexually transmitted diseases such as chlamydia or gonorrhoea amongst others.
  • Damage to the fallopian tubes and reproductive organs – which can be caused by injuries, past surgeries, or endometriosis.
  • Falling pregnant on the progesterone-only pill (POP) or having used the progesterone-containing morning after pill.

Signs and symptoms.

When an ectopic pregnancy has occurred, a woman’s body will recognize the pregnancy and the rise in pregnancy hormone will prevent her regular period from beginning. Women with an ectopic pregnancy can feel morning sickness, breast tenderness, or fatigue associated with early pregnancy. They may also experience light vaginal bleeding. Pain is an early sign of ectopic pregnancy. Pain may be noticed in the abdomen and pelvis. The pain may come and go, and it may be most noticeable on one side of the body. Lower back pain or referred pain felt in the shoulder area may also be experienced.

Symptoms.

As the ectopic pregnancy progresses, there are increased risks for the woman and more symptoms will become apparent. Below are some symptoms of an ectopic pregnancy.

  • Bleeding – It sometimes occurs that a woman does not realise she has an ectopic pregnancy and mistakes the bleeding for her normal monthly period. The bleeding associated with an ectopic pregnancy is usually different from a menstrual period because it may stop and start. Often the blood is brighter or darker in colour than menstrual blood.
  • Feeling faint or dizzy – Symptoms which are a result of internal bleeding, blood loss or a drop in blood pressure. A woman may display signs of shock, such as a weak and rapid pulse, pale skin and confusion. A ruptured ectopic pregnancy is considered a medical emergency. Contact your Obstetrician & Gynaecologist if you notice these symptoms of an ectopic pregnancy.

Confirming an ectopic pregnancy.

  • If there is a chance your pregnancy is ectopic, your obstetrician or another medical professional will
    undertake some tests to check. These tests may include:
  • A blood test – to assess the levels of the pregnancy hormone human chorionic gonadotropin
    (hCG)
  • A pelvic examination.
  • A pregnancy ultrasound of the pelvis to detect the ectopic pregnancy.

It is very difficult to identify early pregnancies (five weeks or less) using a transabdominal ultrasound (an ultrasound across the belly). For this reason, if you have signs of ectopic pregnancy at 6 weeks or earlier, your Obstetrician & Gynaecologist will do an ultrasound through the vagina (transvaginally) to help them see the presence and location of an embryo. 

How it is treated.

Once it is confirmed that the fetus is not located where it should be within the uterus, you will need to have treatment to remove the ectopic pregnancy.

Surgery
Depending on the progress of the pregnancy, the location of the embryo or fetus as well as the amount of internal bleeding, you may need to have surgery. The surgery is most often done with keyhole (laparoscopic) surgery, during which minor cuts are made into the abdomen and the affected tube containing the ectopic pregnancy, tissue is removed.

Medication.
In some cases, a drug called methotrexate can also be given. Methotrexate prevents the embryo from growing anymore, leading the pregnancy tissue to be absorbed back into the body. 

Hormone level monitoring.

Following both surgery and medication, it is sometimes necessary to monitor hormone levels. This helps your treating Obstetrician & Gynaecologist to ensure that all of the ectopic pregnancy tissue has been removed and that there is no more pregnancy tissue left in the body. In rare cases, hormone level monitoring is only as treatment for an early ectopic pregnancy under the care of a Tertiary Hospital or an experienced early pregnancy assessment unit with close follow up is also an option for treatment.

Take care of yourself.
An ectopic pregnancy is essentially a form of miscarriage. Any pregnancy loss, including ectopic pregnancies, can leave you feeling a range of emotions. It can be a traumatic, upsetting, and confusing time for you and your partner.  If you have had an ectopic pregnancy, there is a small increased risk (around 8 – 17%) that you will have another. Many women who have an ectopic pregnancy have a healthy pregnancy later on. There are various forms of treatment for an ectopic pregnancy so it’s critical you speak to a professional to know which is right for you.

Have a question about ectopic pregnancy?

If you have experienced an ectopic pregnancy or consider yourself at high risk, you may have some questions about what this means for your fertility, or concerns about getting pregnant again. Having an Obstetrician & Gynaecologist (a pregnancy and women’s health specialist) alongside you during the early days of your pregnancy will reduce your concerns and alleviate any worries that you are experiencing. 

Dr Caroline Hoggenmueller can provide you with specialist support and advice during this time. When you do decide to try to become pregnant and subsequent pregnancy is confirmed, Dr Hoggenmueller will be there to monitor your health and the progress of your pregnancy. Dr Hoggenmueller provides specialist care to women at an increased risk of ectopic pregnancy or with a heterotopic pregnancy. She consults in Melbourne, Bundoora and Heidelberg, and can be available 24 hours, 7 days a week for women with high-risk pregnancies.