Everything you need to know about ectopic pregnancy, and how it occurs.

They occur in one to two per cent of all pregnancies – but for a lot of women, the subject of ectopic pregnancy can be pretty unknown.

To find out everything there is to know about ectopic pregnancy, we spoke to some of Australia’s leading fertility experts to find out exactly what ectopic pregnancy is, why it occurs and how it’s treated.

Here’s everything you need to know.

What is an ectopic pregnancy and what causes it?

An ectopic pregnancy (also known as a tubal pregnancy) occurs when a fertilised egg implants itself outside of the uterus.

In a normal pregnancy, a fertilised egg would travel through the fallopian tube before implanting in the uterus.

In an ectopic pregnancy, however, the egg instead implants itself outside of the uterus.

“The vast majority of ectopic pregnancies occur, of course, in the fallopian tubes themselves, but sometimes it can even occur in other areas and very rarely it can occur in the tummy,” obstetrician, fertility specialist and gynaecologist Dr Joseph Sgroi told Mamamia.

While ectopic pregnancies only occur in around one to two per cent of all pregnancies, there are a number of reasons for why it may or may not occur.

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease (PID) is one of the more prominent factors associated with an increased risk of ectopic pregnancy.

PID, which is an infection of the female reproductive system typically caused by chlamydia or gonorrhea, can cause significant damage and scarring to the fallopian tubes.

In fact, if left untreated, gonorrhea and chlamydia can even cause the fallopian tubes to become completely blocked – leading to infertility.

Using an analogy, Dr Sgroi explained how scarring or damage to the fallopian tubes can increase your chances of an ectopic pregnancy.

“Imagine you’ve got a pipe and you’re running balls down that pipe,” Dr Sgroi explained.

“But then imagine if in that pipe, you have a little bit of rust deposit – now when you try to run this ball through the pipe, it gets stuck, so it stays there.

“If for whatever reason there’s scarring [in the tube], and the embryo gets stuck, then obviously it can continue to grow there.”

Contraception

While it’s rare to get pregnant while using an intrauterine device for contraception, you’re more likely to have an ectopic pregnancy if you fall pregnant while using an IUD.

Falling pregnant while using a progesterone-only oral contraceptive pill (the mini pill), can also increase risk.

Smoking

According to Dr Sgroi, smoking also plays a part.

“The more that you smoke, the higher the chance that you could have an ectopic pregnancy,” he said.

While typically women are faced with a one to two per cent chance of having an ectopic pregnancy, that chance can go up to two to four per cent if you are a smoker.

Vaginal douching

Vaginal douching is another potential risk factor for ectopic pregnancy, according to Dr. Sgroi.

Tubal surgery

Women who have had surgical procedures involving the fallopian tubes, for example tubal ligation, may be at a higher risk.

History of ectopic pregnancy

If you’ve had an ectopic pregnancy in the past, your chances of having another ectopic pregnancy is heightened.

Dr Sgroi explained that this is because “there’s likely to be a little bit of damage to the fallopian tubes”.

According to Sydney-based fertility specialist Dr Devora Lieberman, there’s also a theory that sometimes an abnormal embryo cannot move normally down into the uterus, thus resulting in an ectopic pregnancy.

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What are the risks of having an ectopic pregnancy?

If not treated, an ectopic pregnancy in the fallopian tube can lead to hemorrhaging or excessive bleeding, which can result in death.

“Having an ectopic pregnancy that occurs within the tube is not compatible with the life of the pregnancy but also not compatible with the life of the woman,” Dr Sgroi explained.

“The pregnancy can invade the tubal wall, encouraging blood flow, and unfortunately if they grow to the point where they’re quite big, those blood vessels can break open, releasing lots of blood within the pelvis of a woman.”

As fallopian tubes are so small, if an embryo begins to grow in the tube, it will eventually erupt.

This eruption can be life threatening to the woman.

What are the symptoms of an ectopic pregnancy?

While a pregnancy complication can sometimes be picked up in a early pregnancy scan, often women also experience signs and symptoms that indicate something is wrong.

Dr Lieberman says the most common first sign of an ectopic pregnancy is one-sided, sharp pelvic pain.

“That [pain] would occur because of bleeding or leaking from the tube and that could irritate the lining of the abdomen, causing pain,” she said.

The pain felt is often described as moderately-severe.

“It’s more sharp pain… it’s not like a period cramp type of pain,” Sydney-based fertility expert Dr Sonya Jessup told Mamamia previously.

Another common sign of an ectopic pregnancy is light to heavy vaginal bleeding or spotting.

“Somebody who is miscarrying will quite often have some bleeding, followed by pain,” Dr Jessup explained.

“But if you’ve got an ectopic pregnancy, you’re more likely to have bleeding, followed by pain,” she said.

Another sign of an ectopic pregnancy is shoulder tip pain or even neck pain.

Referred pain, which is pain felt in another area of the body that is not the source, is often felt in the shoulder and/or neck during an ectopic pregnancy.

“If you’re bleeding into the pelvis and then you lie down, that blood tracks up to under the diaphragm that sends referred pain normally to your right shoulder,” Dr Jessup explained.

Other symptoms commonly described include nausea, diarrhoea and vomiting, as well as weakness and dizziness.

Dr Jessup recommends calling your doctor immediately if you feel you may be experiencing an ectopic pregnancy.

What is the treatment for an ectopic pregnancy?

As the pregnancy poses a serious risk to the life of the woman, it’s important to seek treatment immediately.

There are a number of different treatment options available for ectopic pregnancy, depending on the severity of the condition.

Wait and see

If the pregnancy appears very small on the ultrasound, sometimes the best option is to just wait and see what happens.

This option is used particularly when women are experiencing little to no pain.

“If we find that there’s a tubal pregnancy, and the pregnancy hormone is coming down slow, in some cases we may just continue to observe,” Dr Sgroi explained.

If however, the woman’s abdominal pain worsens or she starts to have heavier bleeding, she may have to use another treatment option to terminate the pregnancy.

Medication

If a woman’s pregnancy hormone levels are higher, medication may be used to remove the ectopic pregnancy.

“If the pregnancy within the fallopian tube isn’t that big, we can utilise a small amount of a chemotherapeutic drug called Methotrexate,” Dr Sgroi said.

Methotrexate, which is used to stop the growth of pregnancy tissue, can only be used if the woman has little to no pain symptoms.

She also has to be regularly monitored while on this medication to ensure the pregnancy hormone is successfully decreasing.

Surgery

If the pregnancy is quite large or her symptoms are ongoing, surgery can sometimes be the only answer.

Surgery is also recommended if a doctor believes you may be bleeding internally or at risk of bleeding internally.

“Sometimes, surgically, the tube can be opened and the ectopic pregnancy removed,” Dr Lieberman said.

“The tube is left intact, but it may not be functioning normally so she would be at an increased risk of an ectopic in the future.”

Sometimes, in more serious cases, it is also necessary to remove part or all of the entire fallopian tube.

But although removing one of the fallopian tubes could reduce fertility, it’s not as big of a decrease as you may expect.

“You would think that if you removed one tube we would decrease the woman’s chance of pregnancy by 50 per cent, but that’s actually not true,” Dr Sgroi explained.

“There’s a small decrease, probably around 82 to 92 per cent of her pregnancy potential.”

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Do I have to wait before trying to fall pregnant again?

Being able to conceive again is a major concern for women who have recently had an ectopic pregnancy.

While some may stress about the possibility of having another ectopic pregnancy, other women are desperate to try again as soon as possible.

The time you should wait before falling pregnant again depends primarily on what treatment option you use.

While some doctors advise women to wait for two to three months before trying again, it can be slightly different on a case by case basis.

If a woman has taken Methotrexate, for example, she will need to wait until the chemotherapeutic drug is completely out of her system before she can conceive again.

It’s also important for women who have used medication to remove the pregnancy to seek medical advice before trying to conceive again, to ensure there’s no ongoing pregnancy tissue present.

On the other hand, if the pregnancy has been removed surgically and the woman has recovered well, she can go on try again once completely recovered.

The chances of falling pregnant again after treatment for an ectopic pregnancy are fairly positive.

Around 65 per cent of women will conceive again within the first 18 months of their ectopic pregnancy, while other studies suggest this can rise to 85 per cent after 24 months.

But there are still increased risks involved.

“The issue is because she’s had an ectopic pregnancy in the past, we’re very conscious that she may have a repeat ectopic pregnancy,” Dr Sgroi said.

Can an ectopic pregnancy ever be successful?

While there have been an extremely small number of rare cases where ectopic pregnancies were brought to full term, it is virtually impossible to have a successful ectopic pregnancy.

“We don’t have the ability to take an ectopic pregnancy from the tube and transplant it into the uterus,” Dr Lieberman explained.

Often when women are told they are having an ectopic pregnancy, they question whether the pregnancy can be simply “pushed” to the uterus.

But at this point, no technology exists to safely move an ectopic pregnancy from the fallopian tube to the uterus without harming the mother or the embryo.

As the embryo has implanted itself in the wall of the fallopian tube, there is no way to detach it without damaging the embryo or the mother.

And even if the embryo could be detached safely, doctors are simply unable to reattach it to the uterine wall.

“It poses too much risk to her [the mother’s] life,” Dr Sgroi said.

“The blood vessels are completely and utterly exposed and have the potential to rupture,” he said.

“There can be catastrophic bleeding.”

If you are concerned about the health of you or your baby, see your GP as soon as possible. If this post has raised any issues for you or if you would like further information on ectopic pregnancies, contact Sands Australia 24-hour support line on 1300 072 637.