Symptoms of ectopic pregnancy and what to do

Ectopic pregnancy is rare, affecting 0.8 to 1 percent of pregnancies. It is extremely dangerous for the mother’s life as well, so we need to address it.

In an ectopic pregnancy, the embryo implants outside the uterus. In 98 percent of cases it attaches in the fallopian tube and starts to develop there. It can also attach in the ovary or the abdominal cavity. Implantation at the cervix also creates a dangerous situation.

In all these cases, similar symptoms to a normal pregnancy are possible, but there can be other signs too. First let us look at the specific symptoms, then what to do next. Finally, we will consider how to reduce the risk and what the predisposing factors are.

Symptoms of ectopic pregnancy 

In this situation, pregnancy essentially begins just like a normal one, so it is not easy to recognise at the start.

Will a pregnancy test detect an ectopic pregnancy 

This question often comes up. The answer is yes, it will clearly detect the pregnancy. On that basis alone we cannot decide anything. In this case the embryo produces hCG, which the test will detect.

As you can read in our summary on the signs of normal pregnancy (link to the blog post on this topic via underlined anchor text): your period is missed, and you may also experience mood swings, breast tenderness and nausea.

However, there are a few signs that may be suspicious, but certainty only comes from medical examination. So if you notice any of the following in yourself, do not panic, but see a doctor immediately, because ectopic pregnancy must be treated urgently.

Symptoms that may suggest ectopic pregnancy:

• Brown, coffee grounds like bleeding (this can also occur with miscarriage)

• Severe, stabbing lower abdominal pain, which can radiate to the shoulders and rectum: dull lower abdominal pain can also occur in normal pregnancy as the uterus grows and makes room. But if these pains are sharp, you must seek medical help at once.

• Low blood pressure, dizziness, weakness, and in extreme cases fainting: if you faint, urgent hospital assessment is required.

If any of the above applies to you, or you have had an ectopic pregnancy before, then after a positive pregnancy test see your doctor as soon as possible, do not wait until week 6. In normal cases, an ultrasound scan is often done around week 6, but in this case we cannot delay seeing the doctor.

You also need an early examination if you have risk factors for ectopic pregnancy, for example: you have used an intrauterine device (coil), had pelvic inflammatory disease or surgery, or you have endometriosis.

If the problem is noticed very early, conservative treatment may be possible, increasing the chances of problem free pregnancies in future.

How it is detected 

If, after a positive pregnancy test, there is no sign of life in the uterus two weeks later, there is a strong suspicion that the embryo must be looked for outside the womb. If it is not seen in the fallopian tube, if it cannot be found on ultrasound at first, then blood tests are needed. As Dr Andrea Sipos, obstetrician gynaecologist, explained, in such cases the hCG level is checked every two days. In normal pregnancy, the amount of hCG in the blood doubles every two days. In ectopic pregnancy it also rises, but at a slower rate

If the examinations confirm that it is indeed ectopic, then at the beginning it may be possible to avoid surgery: medication can be used to stop cell division.

Types of ectopic pregnancy 

We can group the different cases by where the embryo implants:

• Tubal pregnancy: the most common, where implantation happens in the fallopian tube. Normally, the embryo reaches the uterus from the tube in 5 to 7 days. A protective sheath prevents it from attaching sooner and breaks down after 5 to 7 days. If there is scarring in the tube or it is too narrow, the embryo is more likely to get stuck, and after the sheath breaks down it remains in the tube and implants.

• Abdominal ectopic pregnancy: here the embryo finds a place in the abdominal cavity. There have been cases where the baby developed this way, but the chance is minimal. Abdominal pregnancy is also life threatening.

• Cervical pregnancy: this most often ends in miscarriage, but if the embryo implants a little closer to the uterus, it can develop further, which is also dangerous.

• Ovarian ectopic pregnancy: here the fertilised egg remains in the ovary and starts to develop there. Lower abdominal pain, abnormal bleeding and a corpus luteum cyst may be signs.

What to do if it is ectopic 

Sometimes the cells die off on their own and are reabsorbed. In that case only follow up is needed. But if not, and the embryo starts to develop, it can cause such damage in the fallopian tube (or wherever it implanted) that severe internal bleeding can occur. This is life threatening for the mother. Therefore, treatment must begin as soon as possible.

If the reception desk tries to fob you off when you call for an appointment, feel free to be assertive: mention that you suspect an ectopic pregnancy.

If it is still possible, the doctor will suggest medication.
In a more advanced state, surgery helps. If it is not too urgent, it will likely be done laparoscopically to cause the least possible injury. If possible, the fallopian tube is left intact, but in many cases it must also be removed.
If the other tube is healthy, you still have a chance to conceive naturally later.

If the situation is urgent, if there is already internal bleeding, then an immediate open operation is needed. Even then, know that you can still have a healthy baby afterwards. 

It is reasonable to ask how ectopic pregnancy can be prevented. To answer that, let us look at the predisposing factors.

Possible causes of ectopic pregnancy 

The likelihood of the problem can be increased by, for example:

• Pelvic inflammatory disease due to infections or sexually transmitted infections: scarring can form in the fallopian tube, which can hinder the embryo’s journey.

• Previously used intrauterine devices, for example a coil

• Genetic structural changes, thinner fallopian tube

• Previous ectopic pregnancy

• Assisted reproduction

• Smoking: during family planning, give this up as a matter of course, because even in normal pregnancy it seriously endangers the health of both baby and mother.

It is important to know that these are predisposing factors only, so even in these cases ectopic pregnancy is still rare.

Can it be prevented 

Looking at the above causes, we can see that the likelihood of ectopic pregnancy can be reduced to some extent.

Pelvic inflammatory diseases are less common with responsible sexual behaviour, appropriate protection, and a monogamous lifestyle.

You can also reduce the risk by choosing another method instead of a coil.

Before trying for a baby, consult your doctor, who can give personalised advice for prevention and better prepare you for a problem free pregnancy.

Whatever has happened or is happening to you now, many stories show that there is a way forward, and your next pregnancy can be problem free.

Sources:

NHS — Ectopic pregnancy

Tommy’s — Ectopic pregnancy