Ectopic Pregnancy

The very word “ectopic” means “in the wrong place”. An ectopic pregnancy is one that does not occur normally in the womb, but outside the womb.

For 95% of ectopic pregnancies, this unnatural pregnancy takes place inside one of the fallopian tubes. Due to this, ectopic pregnancies are also referred to as tubal pregnancies.

The less common kind of ectopic pregnancy can occur in an ovary, abdominal space or in the cervix.

How does an ectopic pregnancy occur?

Usually, the fertilised egg travels down the tube, from the ovary into the uterus. The egg can take up to five days before it implants itself into your womb. Once embedded into the endometrium (womb lining), the fertilised egg begins to grow and the pregnancy develops.

With an ectopic pregnancy, the fertilised egg does not reach the uterus and so its development begins in the tube.

Why does this occur?

Medical science as yet has not been able to determine exactly why an ectopic pregnancy occurs. What doctors know for sure is that the fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes, usually as a result of the tube being damaged or not functioning correctly.

When is it most likely to occur?

An ectopic pregnancy is most likely to occur between 5 to 10 weeks into your pregnancy.

Am I at risk of having an ectopic pregnancy?

Whilst an ectopic pregnancy can happen to any woman, it is estimated that approximately 1 in 90 pregnancies in the UK develops into an ectopic pregnancy

The circumstances that make an ectopic pregnancy more likely include:

  • Pelvic Inflammatory Disease (PID) – PID, most often caused by chlamydia, can cause damage and scarring to the fallopian tubes.
  • Abdominal Surgery – Any abdominal surgery; including the appendix being removed, a caesarean section, or surgery on your fallopian tubes.
  • IVF Treatment – If you fall pregnant after IVF treatment, you should have an early scan to check where the embryo has implanted.
  • IUD’s – Using a contraceptive intrauterine device (IUD).
  • Previous Ectopic Pregnancies – Previous ectopic pregnancies can increase your risk of another from about 1 in 90 to 1 in 10.
  • Smoking – Smokers are twice as likely to have an ectopic pregnancy than non – smokers.
  • Age – If you are 35 or older.
  • Structural Problems – Your fallopian tubes may be abnormally shaped.

What are the symptoms of an ectopic pregnancy?

For some women, unusual symptoms are not always experienced during the pregnancy and so the pregnancy may only be found to be ectopic on an early scan or once the fallopian tube has ruptured.

For others, the symptoms experienced have been described as:

  • Abdominal pain – Typically on one side of the abdomen, this can range from mild to severe.
  • Bleeding – Abnormal bleeding from the vagina (often mistaken as menstrual bleeding).
  • Shoulder tip pain – A pain experienced at the point where the shoulder ends and the arm begins. Most often, it pains when lying down and can be a signal that internal bleeding has occurred.
  • Bowel pain – Pain may be experienced when passing urine or when experiencing bowel movements.
  • Diarrhoea and vomiting – Ectopic pregnancies can cause symptoms similar to that of a gastrointestinal disease.
  • Shock – If the fallopian tube has ruptured, internal bleeding will occur. This can cause your body to go into shock and you may feel lightheaded and dizzy.

What should I do if I experience any of these symptoms?

Always seek emergency medical advice if you experience symptoms that lead you to believe that you may have an ectopic pregnancy.

In most cases, ectopic pregnancies are caught early enough for the necessary tests and treatment to be administered.

Contact your GP if you notice the following:

  • A change in your normal menstrual cycle
  • Unusual vaginal bleeding
  • Severe and unexplained abdominal pain

Seek emergency medical treatment

The most serious symptom of an ectopic pregnancy is known as ‘collapse’. This occurs when an ectopic pregnancy has split open the fallopian tubes (tubal rupture) and is causing dangerous internal bleeding.

People who have experienced collapse describe feeling light headed and faint. You may also:

  • experience a sharp, sudden, intense abdominal pain
  • feel sick
  • have an increased heart rate
  • look pale
  • have diarrhoea

Treatment

If an ectopic pregnancy is detected early it may be possible to treat this with a medication called methotrexate which stops the egg from developing. The pregnancy is then absorbed into the body. But in about half the cases the egg dies before developing and so methotrexate may not be needed.

If the ectopic pregnancy is detected at a more advanced stage then surgery will be necessary to remove the egg. If it is left to grow then there is a risk that it could rupture (burst) the fallopian tube. This can cause life threatening internal bleeding.

In most cases surgical treatment for ectopic pregnancy will be done laparoscopically. The egg may be removed by making a hole in the fallopian tube but sometimes it may be necessary to remove the fallopian tube.

http://www.babycentre.co.uk/a549381/ectopic-pregnancy

http://www.nhs.uk/Conditions/Ectopic-pregnancy/Pages/Symptoms.aspx

Sisters share their ectopic experiences

Mother A:

About 3 months ago, I was diagnosed with an ectopic pregnancy. I was seven weeks pregnant at the time.  Alhamdulilah, I experienced  pain and my HCG (pregnancy horomone) levels were not that high. I was medically managed with methotrexate, a drug which aborts the embryo. Alhamdulilah I have full faith in Allah and His decree and so I accepted my fate very quickly and realised that it was not meant to be. Alhamdulilah, I have a 2 year old son mashAllah, and have been trying for a second. Allah is the best of planners.

What was hard was the drawn out treatment and follow up process. For 6 weeks, twice weekly, I had hospital appointments/blood test/scans and I suffered from the adverse effects of the methotrexate. I am almost at the end of the two month treatment, Insha Allah. The embryo remains in my fallopian tube and, during my next few menstrual cycles, it will dissolve and leave my body. It has been a long journey and I cannot wait for it to end, insha Allah.

Mother B:

On 22nd December, I found out I was around six weeks pregnant. I knew first pregnancies can end in miscarriage so I tried not to get excited.

A few days later I was reading an article regarding pregnancy discharge. I realised that I had been experiencing the very same thing and tried to make an appointment with my doctor. Unfortunately, it was the Christmas holidays and no appointments were available.

On 31st December, my day went on as usual until I went to the bathroom and noticed that I was bleeding. I called the NHS helpline and went through a whole list of questions.

Although the bleeding was very light, I was advised to go to the hospital for tests. The blood test showed that my HCG levels were around 24. I knew straight away that was wrong. I had known I was pregnant for a couple of weeks and I knew HCG levels double daily and they should have been in the thousands.

The internal examination showed no sign of a baby in my womb. I had been experiencing pain on my left side and this lead the doctor to believe that my pregnancy was ectopic. I was kept overnight and taken for a scan the next morning.

The consultant on duty stated he did not believe I had an ectopic pregnancy. A part of me believed that everything was alright, but another knew that something was very wrong. I was sent home and told to wait for the hospital’s call.

My pregnancy hormone levels, BHCG, were very low. Other signs of ectopic pregnancy are shooting pains in your shoulder tips, rectum, lower back back and on one side of the abdomen. I experienced all of this and more but because I suffer from fibromyalgia, a slipped disc and sciatica, I could not tell the difference between my usual body aches and the ectopic symptoms.

In the New Year, I was sent in for an internal scan which confirmed that my pregnancy was ectopic. The embryo was developing in my left fallopian tube. Usually, after six weeks of pregnancy, if there is no baby in the womb, the body rids itself of the placenta; the body knows the baby is not where it should be.

For me, surgery and alternative methods were not the solution. My only choice was he methotrexate injection; a chemotherapy drug that dissolves the foetus. By taking this drug, you agree that you will not fall pregnant in the following three months (the drug causes deformities in the baby) and should you fall pregnant before the three month period has expired, the pregnancy will have to be aborted.

Taking the injection subjects you to excruciating pain. I mistakenly thought that I would pass the baby out of my body but the doctor explained that the injections dissolve the foetus and it is reabsorbed into the body.

After a month of hospital stay, I was officially discharged and no longer pregnant. And Allah knows best. The most difficult part of having an ectopic pregnancy is dealing with the loss of what could have been.

For me, I was fortunate to have support, understanding and advice from my sister who had experienced the same trauma. Pregnancy and birthing does not come easy to the women in my family, but Alhamdulillah, I have given birth to two beautiful girls since my ectopic pregnancy and Allah knows best.