Ectopic Pregnancies

Many ectopic pregnancies go undiagnosed until it becomes a medical emergency, presenting a danger to the mom. This most commonly occurs between week 4 and week 12 of pregnancy. Ectopic pregnancies are difficult to diagnose as they often present signs that are associated with an oncoming period (missed period) or a possible miscarriage (lower abdominal pain and vaginal bleeding).

• Unusual vaginal bleeding that is different from your period, in that it is either heavier or lighter than usual, with a darker color and more watery composition.
• Pain on one side of the abdomen. This pain can be quite severe.
• Shoulder tip pain.
• If the fallopian tube ruptures, rapid onset of severe pain in the lower abdomen and pain in the shoulder.
• Bowel pain, sometimes with diarrhea and vomiting.

Shoulder tip pain is felt where the shoulder ends and the arm begins. It is not known exactly why shoulder tip pain happens, but it usually occurs when lying down and is a sign that the ectopic pregnancy is causing internal bleeding. The bleeding is thought to irritate the phrenic nerve, which is found in the diaphragm. The irritation to the phrenic nerve causes referred pain—pain that is felt elsewhere—in the shoulder blade.

In around 50% of cases, there are no known risk factors for ectopic pregnancy. Here are some risk factors for ectopic pregnancy:

• Previous diagnosis with chlamydia or pelvic inflammatory disease.
• Previous abdominal surgery or caesarean section.
• Fertility-assisted conception.
• Conception while using an intrauterine device (IUD).
• Conception when on the mini pill (a progesterone-only pill).
• Endometriosis.
• Increased maternal age over 35 years.
• Smoking tobacco.
• A previous ectopic pregnancy.
• Damage to the fallopian tubes due to a ruptured appendix.

To confirm the diagnosis of ectopic pregnancy, a pelvic or vaginal ultrasound with a blood test will usually be done. Medication is usually used to resolve it. If needed, laparoscopic (keyhole) surgery can be done to remove the embryo. It is important to tell your doctor if your medical history includes any known risk factors.

You should also see your doctor immediately if you experience unusual pregnancy symptoms such as cramping, pain or vaginal bleeding.

An ectopic pregnancy cannot normally survive as it does not receive enough blood supply and nutrition. It is treated with the drug Methotrexate, which will stop the growth of the embryo or removed using a laparoscopy (also known as keyhole surgery).

Some women who have had ectopic pregnancies will have difficulty conceiving again. This is more common in women who also had fertility problems before their ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of the damage to your fallopian tubes.

The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 10% chance of having another. If one of the tubes ruptured or was badly damaged, your chances of conceiving again are reduced.

There is little you can do to prevent an ectopic pregnancy from happening in the future, although if your ectopic has been caused by a current chlamydia infection, you can have a course of antibiotics to clear it up and reduce further damage to your tubes.

Ectopic pregnancies can be very scary, but knowing the facts can help you spot a problem early in the pregnancy before it becomes life- threatening. Report any problems to your provider right away and remember there are effective treatments available if you do have an ectopic pregnancy.

When can I start trying to conceive after an ectopic pregnancy?

The general advice is to wait for at least 2 menstrual cycles before trying for another baby. But this depends on your individual circumstances. Speak with your healthcare provider about what is right for you.

I have none of the risk factors. Why would I have an ectopic pregnancy?

Around 50% of women who have an ectopic pregnancy have none of the risk factors. Sometimes there is a blockage or narrowing in the fallopian tubes which is undetectable.