Ectopic pregnancy

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What is an ectopic pregnancy?

An ectopic pregnancy is when a fertilised egg doesn't implant in your uterus (womb). Instead, the pregnancy grows in the wrong place, usually in one of your fallopian tubes.

Ectopic pregnancy is a type of early pregnancy loss. It usually happens 6-8 weeks after your last normal period.

An ectopic pregnancy can happen in:

• your fallopian tubes
• your ovaries
• other parts of your abdomen (tummy)
• your cervix
• a scar from a previous caesarean section

Sadly, there is no way for an ectopic pregnancy to survive. Your pregnancy will end in miscarriage or need to be terminated (aborted).

If your ectopic pregnancy is in one of your fallopian tubes, it can cause the tube to tear or burst. If this happens, it can cause serious internal bleeding.

An ectopic pregnancy can be life-threatening if it causes heavy bleeding.

What are the symptoms of an ectopic pregnancy?

Ectopic pregnancies can cause the following signs and symptoms:

• vaginal bleeding or spotting
• abdominal (tummy) pain
• back pain
• shoulder tip pain
• nausea and vomiting (feeling and being sick)
• a fast heart rate
• dizziness or faintness

These symptoms usually occur between week 4 and week 12 of pregnancy.

If you have any of these symptoms while pregnant, go to the nearest emergency department or call triple zero (000) for an ambulance.

What causes an ectopic pregnancy?

About 1 in every 100 pregnancies is an ectopic pregnancy.

Many women who have ectopic pregnancies don't have any risk factors. But there are some things that can increase your chance of an ectopic pregnancy, including:

• some fertility treatments, such as in vitro fertilisation (IVF)
• past sexually transmitted infections (STIs)
• damaged fallopian tubes
• previous abdominal surgery (such as a caesarean section or surgery for ovarian cysts)
• previous tubal sterilisation surgery
• becoming pregnant while using an intrauterine device (IUD) or a progestogen-only pill
• being 35 years of age or older

Smoking can also increase your chances of having an ectopic pregnancy.

When should I see my doctor?

If you have any of the symptoms of an ectopic pregnancy, see your doctor as soon as possible.

How is an ectopic pregnancy diagnosed?

Your doctor will ask about your symptoms and examine you. They will ask whether you are (or could be) pregnant.

Your doctor may recommend tests, including a:

• blood test for pregnancy hormone levels (hCG level)
• pregnancy ultrasound, which may involve a vaginal ultrasound

How is an ectopic pregnancy treated?

Your doctor will recommend treatment depending on your situation. They may suggest to watch and wait, using medicine, or a surgical treatment.

You will need to have follow-up tests after your treatment to make sure that the pregnancy has fully ended.

Watch and wait

If it seems as though your ectopic pregnancy is miscarrying, your doctor may suggest waiting to see what happens.

Your doctor will only advise this if:

• you are well or have little pain
• the ectopic pregnancy is small and has not ruptured
• your pregnancy hormone (hCG) level is low and going down

You should go to the nearest emergency department or call triple zero (000) for an ambulance if you get symptoms such as:

• abdominal pain
• pain in your shoulder tip
• heavy vaginal bleeding
• dizziness or fainting

Medicine

Medicine to stop the pregnancy growing may be used if:

• your ectopic pregnancy is very small
• there is no sign of internal bleeding

The medicine is called methotrexate. It is given as an injection and takes time to work.

This medicine is not suitable for everyone. Some women may need another injection or surgery to remove the ectopic pregnancy.

Surgery

Surgery may be needed to remove the ectopic pregnancy. Surgery is usually needed if you are bleeding internally or are at risk of bleeding. Surgery may also be needed if medication is not a suitable option.

Surgery for an ectopic pregnancy is usually done as keyhole surgery.

In some cases, your doctor may need to do open surgery or remove your fallopian tube. If this happens, you will need longer to recover.

How soon will I recover from an ectopic pregnancy?

Everyone is different when it comes to recovery and it depends on the treatment you received. Give yourself time to heal.

Physical recovery

The treatment you receive may affect your return to day-to-day activities:

• Exercise —you can start with gentle exercise 2 weeks after keyhole surgery and 6 weeks after open surgery.
• Driving — you may be advised not to drive for the first week after surgery. It's a good idea to start with small trips and build up.
• Return to work — you should be able to return to work within 6 weeks after surgery. This depends how you heal.
• Alcohol — you should not drink alcohol while recovering from surgery. If you were given methotrexate, don't drink alcohol for at least 3 months.

Emotional recovery

Ectopic pregnancy is a kind of early pregnancy loss. There is no 'right way' to feel about a pregnancy loss. It is normal to feel grief. Counselling services are available to support you.

Speak to your doctor if you feel you need support. You are entitled to Medicare-funded counselling with a psychologist if you suffer a pregnancy loss. Your doctor can help arrange this for you.

There are also community support groups — see below.

To find a psychologist near you, use the Healthdirect Service Finder tool.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

Tips for coping with pregnancy loss

Some things that might help you cope with a pregnancy loss are to:

• take your time to heal and grieve
• make healthy food choices and do gentle exercise
• write your feelings in a journal
• speak to your boss about time off if you need it
• find a support group where you can talk to people who have had the same experience

Your partner may also be affected by your pregnancy loss. They may be upset after seeing you go through pain and medical treatment. It can help to be open with your partner so you can process your feelings together.

Will having an ectopic pregnancy affect my future pregnancies?

Ectopic pregnancy and its causes may impact your future fertility.

Talk to your doctor about your situation and whether your fertility is likely to have been affected.

What is my chance of having another ectopic pregnancy?

If you've had an ectopic pregnancy, you have a higher chance of having another one.

This could be because the underlying cause may still be there. Also, the ectopic pregnancy may have damaged or scarred your fallopian tube.

How long should I wait after an ectopic pregnancy before having sex?

Talk to your doctor or healthcare team about when it is safe to have sex again and about your contraception (birth control) options.

How long should I wait after an ectopic pregnancy before trying for another baby?

Before getting pregnant again, it's advised you wait:

• 2 months after surgery
• 3 to 4 months after taking methotrexate

Methotrexate takes a long time to fully leave your body and could be harmful to your next baby.

If you find out you are pregnant again, tell your doctor as early as possible. Your doctor will likely advise you have an early pregnancy ultrasound. This is to make sure that the pregnancy is in your uterus.

Resources and support

Sexual Health Victoria has information and resources about what to expect with an ectopic pregnancy.

Women's & Newborn Health at Westmead Hospital has a detailed resource about the treatment options available for an ectopic pregnancy.

Support and counselling services

You can talk to your doctor or midwife about where to get support. Your hospital may have a social worker you can talk to.

Red Nose Grief and Loss provides support for people affected by pregnancy loss, stillbirth, baby or child death. You can call them on 1300 308 307 – 24 hours a day, 7 days a week.

The Pink Elephants Support Network provides information and support for people who have had a miscarriage.

Bears of hope is a free online and in person support group for people experiencing pregnancy loss.

Grief Australia provides support and counselling for people grieving any type of loss.

Griefline has online support and resources to help you manage with grief and loss.

If you have experienced a miscarriage or pregnancy loss, there are many support services available to help you, your partner and your family. Find a service that is right for you.