Ectopic pregnancy

An ectopic pregnancy or extrauterine pregnancy (EUP) occurs when a fertilised egg implants itself and grows outside the womb.

Overview

An ectopic pregnancy or extrauterine pregnancy (EUP) occurs when a fertilised egg implants itself and grows outside the womb. Causes may include, for example, inflammation in the abdominal cavity or a problem with the fallopian tubes. Vaginal bleeding between periods and dull or throbbing pain on one side of the lower abdomen are suspicious.

Symptoms

  • Missed/late period
  • An ectopic pregnancy often goes unnoticed until it leads to a miscarriage
  • Dull or throbbing pain on one side of the lower abdomen
  • Sometimes spotting
    • Misinterpreted as a late period
    • Usually six to eight weeks after the missed period
    • If bleeding continues too long, risk of anaemia
    • Indicates lack of pregnancy growth (known as withdrawal bleeding)
Most severe progression: tubal rupture
  • Tearing or bursting of a “pregnant fallopian tube”
    • Sudden onset of acute lower abdominal pain
    • Bleeding into abdominal cavity (possibly severe bleeding which can be life-threatening in extreme cases)
  • Risk of a haemorrhagic shock
    • Massive blood loss
    • Danger of bleeding to death
    • Pale, cold and clammy skin
    • Highly elevated pulse rate
    • Often, nausea and vomiting
    • Loss of consciousness
Consequences
  • Increased risk of another ectopic pregnancy
  • Infertility (sterility) if the cause can't be eliminated (e.g. repairing of fallopian tube or removal of adhesions)

Causes and treatment

  • Pregnancy in the “wrong” location
    • Fertilised egg doesn’t make it to the womb
    • Attaches and starts to develop in a fallopian tube, ovary, somewhere in the abdominal cavity (abdominal pregnancy) or cervix

Causes

  • Obstacles preventing passage through the fallopian tube: scars and adhesions in or in the vicinity of a fallopian tube
    • After infections: adnexitis or peritonitis
    • After wearing a coil (intrauterine device) for a long time
    • After fallopian tube surgery or repeated abortions
    • Mucosal polyps or endometriosis lesions
  • Previous ectopic pregnancy: risk of another extrauterine pregnancy is around 10%
  • Fallopian tube dysfunction: fertilised egg isn’t transported to the womb
  • Hormone treatment for infertility
  • Risk increases as women grow older

Further treatment by your doctor / in hospital

Possible tests
  • Abdominal examination
  • Blood and urine tests, incl. pregnancy test
  • Vaginal ultrasound
Possible therapies
  • Pregnancy can't be saved
  • Medicinal termination of pregnancy without surgery (if correctly diagnosed at a very early stage)
  • Operation: usually diagnostic and therapeutic laparoscopy (“keyhole surgery”)
    • Pelvic laparoscopy to confirm diagnosis and remove the fertilised egg and fallopian tube
    • If possible, function-preserving operation for patients who still want children
    • For haemorrhagic shock: emergency abdominal incision to stop the bleeding

What can I do myself?

  • Can’t be influenced arbitrarily
  • Warm stomach poultices and bed rest for abdominal pain
  • Don't delay going to the doctor if an ectopic pregnancy is suspected
  • Indirect prevention by avoiding or obtaining early treatment for adnexitis
    • Follow the safer sex rules: always use a condom or femidom during sexual intercourse, don't get sperm or blood (including menstrual blood) in your mouth, and don’t swallow

When to see a doctor?

  • Vaginal bleeding between periods
  • Unexplained abdominal pain
  • Emergency: sudden onset of severe abdominal pain, combined with vaginal bleeding
  • Generally for a routine examination if pregnancy is suspected
    • An extrauterine pregnancy can be detected by ultrasound from the sixth week of pregnancy

Synonyms

ectopic pregnancy, tubal pregnancy, abdominal pregnancy, EUP, extrauterine pregnancy

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CSS offers no guarantee for the accuracy and completeness of the information. The information published is no substitute for professional advice from a doctor or pharmacist.

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