Ectopic pregnancy

An ectopic pregnancy happens when a fertilised egg settles outside the womb, usually in one of the fallopian tubes that carry eggs from the ovary to the womb.

An ectopic pregnancy cannot grow into a baby, and it cannot be moved or saved. If it keeps growing, the tube can burst and cause serious bleeding inside the body, so it must be found early and treated.

If this is happening to you, it is frightening, and it is also a loss. Getting care quickly gives you the best chance of staying well.

Some women have no symptoms, and the pregnancy is found on an early scan. When there are symptoms, they usually begin between weeks 4 and 12 and can include:

• A missed period and other early signs of pregnancy
• Pain low in the tummy, often on one side
• Vaginal bleeding, or brown, watery discharge
• Pain at the tip of the shoulder

These can also have less serious causes, such as a stomach upset, but if you could be pregnant they need checking.

If you could be pregnant and have one-sided tummy pain with bleeding or brown discharge, get medical help without delay, even without a positive pregnancy test. Tell the staff that you may be pregnant. If you have had an ectopic pregnancy before, or have a risk factor, tell your doctor as soon as you think you are pregnant so that an early scan can be arranged.

Often the cause is not clear. Sometimes the fallopian tubes are narrow, blocked or damaged, so the egg cannot make its way to the womb.

• A previous ectopic pregnancy
• Pelvic inflammatory disease, an infection of the womb and tubes often caused by a sexually transmitted infection
• Endometriosis
• Surgery on the tubes or pelvis, including a sterilisation that did not work
• Fertility treatment such as IVF
• Becoming pregnant with a coil (IUD or IUS) in place, which is uncommon but more likely to be ectopic
• Smoking
• Age over 35

• A burst fallopian tube, with heavy bleeding inside the body, which can be life threatening without quick treatment
• Loss of a tube, which can make it a little harder to conceive, although most women still can
• A higher chance of another ectopic pregnancy, although still small
• Grief, low mood and anxiety, which can last for months

An ectopic pregnancy cannot always be prevented. Condoms lower the risk of the infections that can damage the tubes, and stopping smoking helps.

The doctor will ask about your symptoms and usually arrange a pregnancy test. If an ectopic pregnancy is suspected, you will have an ultrasound scan and blood tests, which may need repeating.

The pregnancy cannot be saved. It has to be removed, or allowed to end on its own under careful watch. The choice depends on your symptoms and test results:

• Careful monitoring: you are watched closely, and another treatment is used if the pregnancy does not end by itself
• Medicine: an injection of methotrexate stops the pregnancy growing
• Keyhole surgery under general anaesthetic to remove the pregnancy, usually with the affected tube. If a tube has burst, surgery is needed as soon as possible

If your blood group is rhesus (RhD) negative, you may be offered an anti-D injection. After treatment, wait at least two periods before trying again, and at least three months after methotrexate, because it can harm a baby.

Grief after an ectopic pregnancy is normal and can last for months. Counselling and the support of family and friends can help. Ask your doctor about support.