An ectopic pregnancy, widely known as a tubal or extrauterine pregnancy, occurs when the fertilised egg implants outside the uterus. About 95% of ectopic pregnancies involve implantation of the fertilised egg in the fallopian tubes. Rarely, the fertilised egg may implant on the surface of the ovary, in the cervix, or in neighbouring organs. However, in all these ectopic locations, the embryo cannot develop, and the pregnancy cannot progress. Most ectopic pregnancies require surgical management or, if diagnosed early, may be treated with medication. Early treatment is crucial so that a woman may later achieve a normal pregnancy, if she wishes.
What are the symptoms of an ectopic pregnancy?
Common symptoms and clinical signs include missed periods, a positive pregnancy test, vaginal bleeding, abdominal pain, and fainting. In the early stages, the symptoms are similar to those of a normal pregnancy, such as frequent urination, nausea, and breast tenderness.
Common symptoms of ectopic pregnancy include:
- Missed or delayed period
- Feeling nauseous
- Vomiting
- Fatigue
- Breast pain, tenderness, or swelling
- Frequent urination or constipation
- Vaginal discharge
- Heightened sense of smell
- Changes in appetite and taste
Symptoms that do not align with a normal pregnancy may include:
- Vaginal bleeding
- Abdominal or lower pelvic pain
- Diarrhea and stomach discomfort
- Pain during bowel movements
- Back pain
- Generalised weakness
- Dizziness
How is the diagnosis made?
Today, ectopic pregnancy is usually diagnosed early through physical examination, measurement of beta-human chorionic gonadotropin (β-hCG) in blood or urine, and ultrasound imaging. A key goal is early detection so that appropriate treatment can be given promptly. Rupture of an ectopic pregnancy may cause internal bleeding, requiring emergency surgery.
What are the risk factors for ectopic pregnancy?
Risk factors that increase the likelihood of ectopic pregnancy include:
- Previous inflammation or infection of the fallopian tubes (pelvic inflammatory disease)
- Previous surgery on the fallopian tubes (such as tubal sterilisation reversal or other tubal procedures)
- Previous ectopic pregnancy
- Conception despite the use of an intrauterine device (IUD) or progesterone-only contraceptive pills
Treatment of ectopic pregnancy
Treatment options include medical management with methotrexate or surgical intervention. Ectopic pregnancies are often diagnosed and treated laparoscopically (a minimally invasive method). If there is severe or uncontrolled bleeding, an open surgery (laparotomy) may be necessary, using an incision just above the pubic hairline.
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