Ectopic pregnancy

What is an ectopic pregnancy?

Ectopic pregnancy is one kind of early pregnancy loss. It is a potentially life-threatening complication that occurs in about 1 in 100 pregnancies.

An ectopic pregnancy is when the fertilised egg does not implant in the uterus, and the pregnancy grows in the wrong place. This happens most commonly in the fallopian tube, although it can also occur on the ovary, or in a scar from a previous caesarean section, or in other parts of your abdomen. Sadly, there is no possibility for an ectopic pregnancy to survive, and the pregnancy will end in miscarriage or need to be terminated (aborted).

Are there any risk factors that might increase my chances of having an ectopic pregnancy?

Many women who have ectopic pregnancies do not have any pre-existing risk factors. But there are some situations that do increase your chance of an ectopic pregnancy, including:

• fertility treatments
• past pelvic infections
• damaged fallopian tubes
• previous abdominal surgery (such as caesarean section, or ovarian cysts)
• becoming pregnant while using an intrauterine device (IUD)
• previous miscarriage
• smoking
• age 40 and older

What are the symptoms of an ectopic pregnancy?

Ectopic pregnancies can cause the following signs and symptoms:

• irregular vaginal bleeding (spotting)
• abdominal pain
• shoulder tip pain
• fast heart rate
• dizziness or faintness

How would I know if I have an ectopic pregnancy?

Many of the symptoms of an ectopic pregnancy could also be due to other causes, so check with your doctor before you start to worry.

If your doctor is concerned you may have an ectopic pregnancy, they will most likely recommend a transvaginal ultrasound. The combination of a positive pregnancy test and no implanted pregnancy in the uterus is an indication that you have an ectopic pregnancy. However, there are other possible explanations so your doctor will continue to measure your pregnancy hormone levels with blood tests. If you have an ectopic pregnancy, your blood hormone levels are usually lower than normal and will rise more slowly.

How will my ectopic pregnancy be treated?

An ectopic pregnancy must be treated to stop it from growing. There are 3 main options for treatment depending on your situation:

• Surgery — if surgery is recommended, it is usually keyhole surgery. It may be possible to make a cut in the fallopian tube and remove the ectopic pregnancy leaving the tube intact. In some cases, your doctor may need to remove your fallopian tube altogether.
• Medication — if you are early in your pregnancy and there is no sign that you have internal bleeding, your doctor might recommend a medicine called methotrexate to stop the pregnancy. It is given as an injection which takes time to work and may sometimes require a follow-up injection or surgery.
• ‘Watch and wait’ — if it seems as though your ectopic pregnancy is miscarrying on its own, your doctor may suggest that you wait for a while and see what happens naturally. If this is the case, you will most likely not feel any pain. If your doctor decides to wait and see, you will need to have follow-up tests to make sure that the pregnancy has completely ended. Although this may be scary, if a doctor recommends this approach, there is almost a 90% chance that you will not need any extra treatment.

What happens if my ectopic pregnancy is left untreated?

In a normal pregnancy, the uterus grows as your baby grows. In an ectopic pregnancy, the fallopian tube cannot grow and expand the same way, so your pregnancy risks overstretching the tube as it grows. This can be very painful and cause the tube to tear or burst. If this happens, it can cause serious internal bleeding, and may even be life threatening.

Will having an ectopic pregnancy affect my chance of having a successful pregnancy in the future?

Ectopic pregnancy and its causes may impact your future fertility, but you still have a good chance of conceiving and having a successful pregnancy.

What is my chance of having another ectopic pregnancy?

If you have had an ectopic pregnancy, you have a higher chance of having another one. This is partly because the underlying cause may still be there and partly because the ectopic pregnancy may have damaged or scarred the fallopian tube. It may be reassuring for you to know that 9 out of 10 future pregnancies will not be ectopic.

What support is available to me if I have had an ectopic pregnancy?

Ectopic pregnancy is a kind of early pregnancy loss. It is normal for women and families to feel grief, so remember that counselling services are available. Please speak to your GP if you feel you need support. You are entitled to Medicare-funded counselling with a psychologist if you suffer a pregnancy loss and your doctor can arrange this for you. There are also community support groups. Your doctor can recommend some to you.

To find a psychologist near you for pregnancy loss support, ask your GP or obstetrician or use the Service Finder.

How long should I wait before trying for another baby?

If you have had medical treatment or taken the ‘watch and wait’ approach, you can have sex with your partner again once your hormone levels reach zero. If you have had surgery, you should wait until the pain and bleeding stop, which usually takes 2 to 3 weeks. Although you may try for a pregnancy as soon as you and your partner are ready, it is recommended to wait 3 months after surgery or the ’watch and wait’ approach, and 4 months after taking medical treatment.