Ectopic Pregnancy - What It Is
Ectopic pregnancy, also known as a tubal pregnancy, occurs when the pregnancy implants outside of the womb.
It can occur in several places, for example, the ovary, the abdomen, the cervix, at the join between the tube and the womb (cornua), but the most common place is within the fallopian tube.
Pregnancy can even occur in both the womb and the tube at the same time (heterotopic pregnancy), but this is rare, occurring in only about 1/10,000 pregnancies.
What causes the ectopic pregnancy?
Many factors are known to increase the risk of having an ectopic pregnancy. Anything that alters the tubal function may affect further pregnancies. Fallopian tubes aren't like a hollow pipe that sits there with the egg rolling down.
They have little hairs on the inside (cilia) which move with a wave-like motion to encourage the egg toward the womb. If the tube becomes blocked or the cilia damaged then ectopic is more likely.
Often none of the risk factors below are present and there is no obvious reason - it was just bad luck.
• Advancing age
• Pelvic inflammatory disease (PID) — e.g. previous chlamydia or gonorrhoea. Infection causes scar tissue adhesions in the tube and may damage the cilia. PID is one of the main causes of the increase seen in ectopic pregnancies in recent years. Risk of an ectopic pregnancy increases about seven-fold after a woman suffers acute pelvic infection.
• Tubal surgery — women who have had operations on their tubes are more at risk of ectopic. This includes tubal ligation, reversal of sterilisation or tubal surgery for a previous ectopic.
• Previous ectopic - about 10-20 per cent of those attempting pregnancy after one ectopic will have another.
• DES exposure - this is a drug that was once used during pregnancy, until it was found that female babies of women who used it were at risk of developmental abnormalities of the genital system.
Their tubes are more likely to be abnormal and predisposed to ectopic pregnancy. This is a very rare problem and you would most likely already know about it.
• Previous termination of pregnancy — the risk of ectopic increases among those who have had two or more termination, particularly if there was infection afterwards.
• IVF (test-tube baby) and ovulation induction — both these techniques of assisted reproduction are associated with increased chances of ectopic pregnancy.
How would I know if I've got an ectopic?
Ectopics tend to present in one of three ways:
As an emergency. Suddenly, without warning a woman is very unwell, collapses and is taken to hospital. A positive pregnancy test is found and she is transferred to theatre and a ruptured ectopic is found with bleeding into the abdomen.
The second group are known to be at risk of an ectopic pregnancy, for example she may have had an ectopic previously, may have undergone tubal surgery or assisted conception (such as IVF). Early detection of ectopics are high in this group of women as routine checks are made to ensure that the pregnancy is where it should be fairly early on.
Less than 20 per cent of ectopics present this way. Finally, the most common presentation is with a missed period, positive pregnancy test, some abdominal pain (usually to one side), and some irregular vaginal bleeding. Some women report fainting or shoulder-tip pain