Ectopic Pregnancy

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. Ectopic pregnancy affects one in every 80-100 pregnancies. It is a life-threatening condition and a gynaecological emergency. The incidence of ectopic pregnancy is rising due to the increased incidence of Chlamydia trachomatis. Most ectopic pregnancies implant in the fallopian tube and, as the pregnancy grows, cause bleeding and pain. If not treated in time, the tube can rupture and cause severe bleeding, which can lead to collapse and death.

Risk factors

A key factor in early diagnosis is to identify those women who may be at risk. Common causes and risk factors include:

  • Damage to the fallopian tube causing blockage or narrowing so the eggs cannot move into the uterus
  • Previous pelvic infection
  • Chlamydia. This infection is increasingly common in young women
  • Previous appendicitis
  • Women with a history of infertility
  • Caesarean section
  • Women aged 35 or older
  • Smoking

However, in many instances the cause is not known.

Symptoms

It is essential that any woman of childbearing age be investigated appropriately if any symptoms of this condition are displayed. The most common are: 

  • Abdominal pain: this is usually one-sided, but not necessarily the side of the ectopic pregnancy
  • Bleeding that could be just spotting or abnormal bleeding. The blood is often darker than a normal period
  • Shoulder tip pain, which can be caused by irritation to the diaphragm caused by internal bleeding, and is a classic sign of ruptured ectopic pregnancy
  • Bladder and bowel problems: pain when going to the toilet and a feeling of pressure in the bowels
  • Dizziness, pallor and nausea
  • Collapse

The woman may not know she is pregnant or may think she is having an unusual period. In addition she may have been fitted with a coil.

Some women express a feeling that something is very wrong; this is often accompanied by a feeling of impending doom. Pregnancy testing may be positive but this is not always the case. Up to 75 per cent of women may present with subacute symptoms.

Management

It is vital to diagnose an ectopic pregnancy early to prevent further damage to the tube and reduce the likelihood of morbidity as well as trying to preserve fertility.

  • Give pain relief
  • Urine dip including pregnancy test
  • bHCG blood test and routine ED bloods
  • Early referral to O & G once pregnancy confirmed
  • Fluid resuscitation if required

If diagnosis is made early before the tube ruptures, keyhole surgery or drug treatments such as methotrexate can be offered. This promotes a quicker recovery time and increases women’s chances of future fertility.

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