Any pregnancy that occurs outside of the uterus is called an ectopic pregnancy. The most common site for an ectopic pregnancy is in one of the fallopian tubes that lead from the ovary to the uterus. During conception a woman’s ovum (female egg) is usually fertilized by the sperm in the narrow fallopian tube. This fertilised egg begins to divide and moves into the uterus over the next couple of days. If the fallopian tube is scared or narrowed the pregnancy may implant in the tube. Ectopic pregnancy occurs in about 1 in 100 pregnancies. It is vital that ectopic pregnancy is diagnosed early to prevent serious health consequences for the mother.
Some women are at greater risk of an ectopic pregnancy than others. These include: women who have had surgery on their fallopian tubes; women who have had pelvic inflammatory disease; women who have an intrauterine contraceptive device and women who have had an ectopic pregnancy previously. The reality is, however, that a substantial number of women that experience ectopic pregnancies have no identified risk factors at all. This is why it is important that all sexually active women are aware of the symptoms.
Typically women with ectopic pregnancies will present to their doctor or the emergency department having missed a period. They may feel they are pregnant or have done a pregnancy test, which is positive but have now started to bleed. What happens is the pregnancy will have grown to the limits of the fallopian tube and begun to fail. The hormones will begin to drop and bleeding will occur from the lining of the uterus, as occurs normally with a period. The pregnancy may, however, invade through the wall of the fallopian tube rupturing blood vessels and causing a serious internal haemorrhage to occur. The bleeding is usually associated with pain. If untreated shock will develop and in more serious cases the woman can die. Ectopic pregnancy is considered to be a medical emergency.
Any woman who is sexually active and has missed a period and then has bleeding accompanied by pain should seek medical help immediately. A pregnancy test will then be done as well as an ultrasound to see if there is any evidence of a pregnancy in the uterus or outside the uterus.
Management of an ectopic pregnancy will depend on whether the pregnancy has begun to fail and the hormones are dropping or whether it is still growing and the pregnancy hormone levels are high. It also depends on the physical state of the woman such as if shock is developing. Surgery to remove the pregnancy from the fallopian tube is still very common. If possible the doctor will try to conserve the fallopian tube. Sometimes it is possible to wait for the pregnancy to be absorbed naturally without resorting to surgery.
If a fallopian tube is removed women should still be able to get pregnant through the other tube. This does reduce the chances of a pregnancy though as you tend to ovulate out of alternative ovaries each month. Women who have had an ectopic pregnancy will be asked to be extra vigilant with any future pregnancies because of the increased risk of this occurring again.