A pregnancy is ectopic if it develops outside the uterus. Most ectopic pregnancies
are found in the fallopian tube, although they can occasionally occur at
other pelvic sites. If a tubal pregnancy is allowed to continue, it may eventually
rupture the fallopian tube and cause a life threatening haemorrhage. Early
diagnosis is therefore important, and may even save the tube.
SYMPTOMS
Initially, an ectopic pregnancy may appear as a normal pregnancy—a
missed menstrual period and symptoms, such as sore breasts and nausea. However,
there is often abnormal vaginal bleeding which may occur at the time of (or
a little later) the expected period, and may be mistaken for a period. Commonly,
pain on the side of the ectopic occurs and may be associated with a feeling
of light-headedness or a desire to use one’s bowels. If the tube ruptures,
this usually results in severe abdominal pain and fainting.
DIAGNOSIS
Firstly a pregnancy must be confirmed by a serum (blood) pregnancy
test at the Canberra Fertility Centre. These tests are more sensitive than
a urine test and if negative, can virtually exclude any risk of a significant
ectopic pregnancy. If the test is positive, then an ultrasound scan can usually
establish whether the pregnancy is in the uterus. Sometimes a pregnancy sac
may be seen outside the uterus, and therefore confirm the diagnosis. However,
identifying an ectopic pregnancy maybe very difficult and a laparoscopy is
often the only way of confirming the diagnosis if no pregnancy can be seen
in the uterus. This is a technique whereby a fine telescope is inserted near
the umbilicus (belly button), which allows the gynaecologist to visualise the
pelvic organs. A pregnancy in the fallopian tubes can be easily seen.
WHO IS AT RISK?
Ectopic pregnancy occurs about once in every hundred pregnancies.
However, some women are at a slightly higher risk than this. Important risk
factors are:
• An intrauterine device (IUD);
• The morning after pill;
• Progesterone
only or mini pill;
• Tubal damage caused by infection;
• Tubal surgery,
eg tubal ligation or sterilisation reversal;
• IVF and GIFT; and
• A
previous ectopic pregnancy.
Women who are at an increased risk may be advised
to have an ultrasound scan early in the pregnancy, particularly if they have
any vaginal bleeding.
TREATMENT
Traditionally, tubal pregnancy has been treated by removing the
fallopian tube involved. However, newer and more sensitive tests mean that
doctors have the means to make the diagnosis earlier, so that the tube can
often be preserved. It may be possible to remove the pregnancy using the
laparoscope, thus avoiding major surgery. Chemical methods of treating ectopic
pregnancies are also now becoming available. These should be discussed with
your doctor.
CONSEQUENCES
With an ectopic pregnancy, a couple not only
mourn the loss of a pregnancy, but also the possible loss or reduction
in their fertility. This sense of loss is accompanied by the discomfort
and anxiety of having an emergency operation. For a woman who is potentially
fertile and has a remaining fallopian tube, pregnancy is still possible.
Other choices available to her and her partner are IVF, adoption or childfree
living. The decision process involved in making these choices can be assisted
by the support of the counsellor at the Canberra Fertility Centre.
