Ectopic Pregnancy (6-12 Weeks)
During the process of conception of pregnancy, egg and sperms meet just outside the fallopian tubes of the uterus. Fallopian tubes are narrow thin tubes that guide the sperms towards the ovaries, where the ovulated free egg is awaiting to be fertilized. Once fertilization happens, the small bundle of newly formed conception cells (blastocyte) starts multiplying and growing. In the meantime, it starts to travel back towards the cavity of the uterus via the fallopian tubes. This migration usually takes around 5-6 days, and the embryo implants itself within the lining of the uterus (endometrium). This is the natural and correct place for the pregnancy to be as the muscle of the womb can stretch and carry the baby for 9 months.
Sometimes this process is interrupted by either previous pelvic infections, local adhesions, variants in female anatomy, or any other reason and the conception implants itself into any nearby structure, such as ovary, pelvic floor, bowel, and the fallopian tube and therefore pregnancy is ectopically placed outside the womb lining. Ectopic pregnancy cannot carry on as none of the mentioned sites are designed to carry a pregnancy.
The following symptoms could mean that your fallopian tube has split open (ruptured).
1. A sharp, sudden, and intense pain in your tummy
2. Feeling very dizzy or fainting
3. Feeling sick
4. Looking very pale
This is very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible. Ectopic pregnancy can become a life-threatening situation for the pregnant mother.
A rupture can be life threatening, but fortunately they’re uncommon and treatable, if dealt with quickly. Deaths from ruptures are extremely rare in the UK.
Since the pregnancy is not inside the womb, the lining of the womb which had thickened to house the pregnancy, can start to shed and bleeding can be experienced by pregnant mother. This could be the first sign of an ectopic pregnancy as well as pain on the affected side. Some patients might be feeling faint and unwell in general, have headaches, one sided pelvic pain, general abdominal pain, or any unusual symptoms. Symptoms can include a combination of:
1. A missed period and other signs of pregnancy
2. Tummy pain low down on 1 side
3. Vaginal bleeding or a brown watery discharge
4. Pain in the tip of your shoulder
5. Discomfort when peeing or pooing
A positive BHCG pregnancy blood test confirms that you are pregnant, but it cannot tell us where it is implanted and growing. An early Pelvic transabdominal and transvaginal ultrasound scan (Ectopic pregnancy) can determine the site of pregnancy and rule out possibility of an ectopic. However, if the gestation is too early, neither ectopic nor intrauterine pregnancy can be seen. In these cases, serial βHCG hormone check-up (Blood test) and serial Ectopic pregnancy (Pelvic) ultrasound scans few days apart is necessary to check the progress of the pregnancy.
Very rarely twin pregnancy can have two sites with one inside the womb and one ectopically placed. Even though this is very unlikely to happen, but the only way to find out is by ultrasound scan.
In London private ultrasound, we perform Transabdominal and Transvaginal ultrasound scan (Ectopic Pregnancy) as early as end of the 5th to 6th weeks of the pregnancy to confirm the accurate progression of pregnancy, and this will put your mind at rest. βHCG blood test also can be performed on site. Repeat transvaginal Pelvic ultrasound scans, (Ectopic pregnancy ultrasound scans), blood tests, and follow up scans can be arranged to follow the active process of pregnancy if the gestation is too early or the results are borderline, dubious or inconclusive.
You can have a Transvaginal scan as early as the end of the 5th week towards the beginning of the 6th week till the 12th week of gestation to find out if the gestation sac is growing in the correct place inside the lining of the womb.
If ectopic is confirmed by transvaginal ultrasound, a report is printed and signed and an information booklet is given to you physically. You are required to go to your local or the nearest hospital ASAP for urgent care with this report. All images and reports are also sent to you digitally straight away.
You will be referred to the early pregnancy unit. Usually, a second scan is performed to confirm the findings. Then you will be treated based on these findings. Sometimes medication is sufficient to let the body heal the site of the ectopic pregnancy. Most often due to the site of ectopic pregnancy, an emergency operation is carried out and the ectopic is removed. Ectopic pregnancy can become a life-threatening situation for the pregnant mother.
If the pregnancy is not inside the womb and cannot be identified in any place outside the womb, you are asked to have a βHCG blood test. This test gives a hormonal level based on weeks of pregnancy and maybe the pregnancy is earlier than expected. After the test is done serial repeat scans (usually every 3 days) are required to check the progress of the pregnancy either inside or outside the womb.
Ectopic pregnancy can have a wide range of signs or NO signs at all. Usually, some bleeding might happen, and sometimes pelvic pain is present. Some people might present with unusual signs from headaches to generally feeling unwell. Some are just genuinely worried about having ectopic or previously have had it and are very anxious in their current pregnancy.
Anyone can have an ectopic pregnancy, however, if there is any previous history of pelvic inflammatory disease or adhesions or surgical scars, the risk might increase.
Reports of the scan are sent to you digitally as promptly as 1-2 hours after the scan.
The scan usually takes 20 minutes; however complicated cases might take longer than average.
There are 3 main treatments for ectopic pregnancy:
Expectant management – you're carefully monitored and 1 of the treatments below is used if the fertilised egg doesn't dissolve by itself
Medication – an injection of a powerful medicine is used to stop the pregnancy growing
Surgery – keyhole surgery (laparoscopy) is performed under general anaesthetic to remove the fertilised egg, usually along with the affected fallopian tube.
Most women can leave the hospital a few days after surgery, although it can take 4 to 6 weeks to fully recover. If your fallopian tube has already ruptured, you'll need emergency surgery.
Statistically, the chances of having a future successful pregnancy are very good and 65% of women are healthily pregnant within 18 months of an ectopic pregnancy. Some studies suggest this figure rises to around 85% over two years.
Most women who experience ectopic pregnancy and treatment will achieve a successful pregnancy in the future, even if they've lost one fallopian tube as part of the therapy. There is a 10% risk of recurrence, which is why it's important to work with your health care team when planning for a future pregnancy.
Studies show similar rates of conception after an ectopic pregnancy, regardless of how it was treated, and numbers are high–up to 80% will go on to have a live birth. However, the risk of another ectopic is still increased in future pregnancies.
The easy answer is yes: You can deliver a healthy, full-term baby after an ectopic pregnancy.
Removal of one fallopian tube won't make you infertile. You'll still need contraception. Removal of both fallopian tubes means you can't conceive a child and won't need contraception. However, if you still have your uterus, it may be possible to carry a baby with the help of in vitro fertilization (IVF).
Most women without fallopian tubes who have successful pregnancies become pregnant through in vitro fertilization. Otherwise, the pregnancy is likely to be an ectopic pregnancy that has to be terminated.