When pregnancy goes wrong and is ectopic

Discovering they are pregnant can be one of the most exciting times in a woman’s life, until they discover that they have an ectopic pregnancy.

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. This means the egg will not develop. Occasionally, an ectopic pregnancy doesn’t cause any noticeable symptoms and is only detected during routine pregnancy testing. However, most women do have symptoms, and these usually become apparent between the 5th and 14th weeks of pregnancy. The symptoms of an ectopic pregnancy can be found here. An ectopic pregnancy does not allow the foetus to develop properly, and left untreated can be fatal to the mother.

Treatment can be by medication and/or surgery and is determined by the individual circumstances of the woman and the ectopic pregnancy.

Medication (Methotrexate) is offered as a first line treatment if a woman is diagnosed with an ectopic pregnancy, is able to return for regular follow up checks to confirm that it is working, and if they have all of the following:

– no significant pain,
– an unruptured ectopic pregnancy,
– a blood Human chorionic gonadotrophin (hCG) level less than 1500 IU/litre (known as the pregnancy hormone),
– no intrauterine pregnancy (a ‘normal’ pregnancy in the womb).

If the hCG concentration increases excessively within a short period of time it is likely the woman is developing an intrauterine pregnancy.

Surgery is the most common treatment offered. The surgery will either be the more conservative laparoscopic salpingotomy, where a small cut is made in the fallopian tide to remove the ectopic cells; or a salpingectomy where the fallopian tube is removed along with the egg. A salpingotomy should be considered if the woman has other risk factors for infertility eg the other fallopian tube is already damaged. This may also need follow up treatment of methotrexate and regular blood tests to confirm the level of hCG is dropping and all the ectopic cells have been removed. A salpingectomy will be performed if the ectopic pregnancy is too large, or if the woman is unable to return for follow up checks, or if the level of hCG in the blood is 5000IU/litre or more.

If a woman has had a salpingotomy and the hCG level is not monitored sufficiently and remains elevated, then it is possible that ectopic cells remain (known as a persistent trophoblast). If this is missed then she may suffer a tubal haemorrhage and require further surgery to remove the fallopian tube (salpingectomy) and the ovary (oophorectomy).

If you have suffered an ectopic pregnancy and have any concerns in relation to the care and treatment you received please contact us for a confidential discussion.

The Ectopic Pregnancy Trust is a charity supporting people who have experienced an early pregnancy complication and the health care professionals who care for them. Their website can be found here www.ectopic.org.uk/