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

Exclusion of liability

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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