coping with ectopic pregnancy

by Kirsty Stretton-Cox

coping with ectopic pregnancy | help and info

An ectopic pregnancy is simply one that occurs outside the womb.

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Once reported at a low incidence rate of around 0.25% of births, ectopic pregnancy is becoming more common. It is thought that over 1% of pregnancies in the UK are ectopic and figures are rising even more steeply in many countries. In Jamaica there is an unusually high rate of ectopic pregnancy (one ectopic pregnancy for every 28 successful deliveries).

In over 95% of cases the egg implants in a Fallopian tube, having failed to progress to the womb due to a swollen or damaged tube. In rare cases an ectopic pregnancy can occur in an ovary, in the abdominal cavity or in the cervix.

Ectopic pregnancy is a dangerous complication and potentially life threatening, so it is best to treat warning signs seriously. A doctor should be contacted immediately if mild symptoms occur. Severe symptoms should be treated as a hospital emergency.

signs

Some ectopic pregnancies miscarry early and are never diagnosed. Ectopic pregnancies that develop usually cause symptoms that lead women to seek help between the 4th and 10th week of pregnancy and most commonly between 6 and 7 weeks. It is possible to have an ectopic and have none, one or all of these symptoms.

Typical signs, following an overdue period or positive pregnancy test, are:

bleeding from the vagina (can be light to heavy and often dark in colour)
lower abdominal pain, usually on one side, which may be immediate and violent or increase slowly
fainting or collapse
shoulder tip pain (caused by the diaphragm being irritated by internal bleeding)
bladder or bowel problems, such as pain when moving the bowels
sickness and diarrhoea

diagnosis

Diagnosis techniques are improving all the time but it is still possible that diagnosis of the condition can take several days to establish. It may be hard to think about anything else during this time. Don't feel afraid to turn to your doctor, friends and family or professional organisations for advice and support during this period. There are few experiences as intense as ectopic with all its associated implications and nobody should be expected to handle it alone.

causes

Often there is no known reason for an ectopic pregnancy. However, the chances of experiencing one can be raised by:

Inflammation of the Fallopian tubes caused by Pelvic Inflammatory Disease (PID) – ectopic pregnancy is on the increase in the UK due to a dramatic increase in sexually transmitted diseases, leading to an increase in PID. About 50% of women operated on for ectopic pregnancy have evidence of PID.
Previous ectopic – about 10-20% of those attempting pregnancy after one ectopic will have another.
Previous abdominal surgery – such as caesarean section, surgical fibroid removal or appendectomy, or previous surgery to the Fallopian tubes.
Previous termination of pregnancy – the risk of ectopic increases among those who have had two or more terminations, particularly if there was infection afterwards.
Certain contraceptive methods – becoming pregnant while using a contraceptive coil or the progestogen-only contraceptive pill (mini-Pill).
In Vitro Fertilisation – despite being placed within the womb, the fertilised egg may still attach itself outside the cavity of the uterus.
Endometriosis – tubal damage or scarring can make a blockage more likely

treatment

An ectopic pregnancy cannot survive and has never yet been successfully moved to the womb.

If early diagnosis is made, and there are few symptoms, it may be possible to avoid surgery by treating the condition with the drug methotrexate, which makes the ectopic pregnancy shrink away by stopping the cells dividing.

However, treatment usually involves urgent surgery to remove the embryo. Laparoscopic surgery is carried out under general anaesthetic and involves making a small incision in the abdomen to access the Fallopian tube. A damaged tube will be repaired if possible but a badly damaged tube will be removed to prevent a recurring ectopic pregnancy.

Sometimes follow up blood tests or scans may be necessary to check the ectopic pregnancy has been successfully removed.

recovery

Suffering an ectopic pregnancy is an overwhelming process. It can be extremely frightening and it will take a while to heal both physically and emotionally.

emotional recovery

There is often a feeling of devastating sadness at having lost the pregnancy, combined with a strong fear for future pregnancies and a need to ask 'why me?' The worry of dealing with the ectopic and any surgery involved can make it easy for people to forget that you have lost a usually much-wanted pregnancy.

Depending on how soon the ectopic is discovered and in what manner it is treated, ectopics can involve a traumatic element of pain and fear. Feeling anxious or depressed are further unsurprising side effects of ectopic pregnancy and it takes time to get over the hormonal adjustments your body has to make after a terminated pregnancy. Recovery requires gentle understanding, assurance about close medical monitoring for the next pregnancy, and time. Feeling well informed about what has happened to you and why helps gain peace of mind and aids recovery, too. Remember that it is usual to need time to get back on your feet again. Don't feel embarrassed to ask for help or space.

physical recovery

The treatment route taken, allowing for possible complications like tube removal or rupture, largely governs physical recovery from an ectopic pregnancy. Surgery will take more time to recover from physically than treatment with methotrexate. All ectopic pregnancies are likely to take some time to recover from physically, as the body tries to regulate hormone levels and mend any damage caused by the pregnancy. Basically speaking, most surgery will take six weeks to heal.

Physical side effects vary widely in their type, intensity and longevity but more common ones are:

General soreness and fatigue from the surgery.
Bloating due to inflammation caused by the surgery. This should subside quickly.
Breast tenderness – short term, as hormone levels settle.
Pelvic pain or pain at ovulation – caused by adhesions from the surgery. This should settle within a few weeks.

Even following the removal of both tubes you will continue to have periods. Your first period after the ectopic may well be heavier, lighter or possibly more painful than usual but things should return to normal with the next period. There is no evidence that ectopic pregnancy has a long-term effect on menstrual periods or affects the timing of menopause.

If you experience abdominal pain which continues after the ectopic then ask your doctor to make sure you do not have a persistent infection that might contribute to a future ectopic.

when can I start having sex / try to become pregnant again?

Individual advice from your doctor is best but it would normally be advisable to wait around 6 weeks to allow full healing before you have sex.

The risk of a further ectopic decreases the longer you leave it before trying to get pregnant again. You should ideally wait until after your first normal period before you stop using contraception.

future pregnancy

Talk through your individual situation with your doctor or consultant. Statistically, even if one Fallopian tube is removed you have a 50% chance of having a future normal pregnancy. If the tube was saved the chance increases to around 60%. With both tubes removed IVF treatment can still offer some hope of a successful pregnancy.

(April 2004, resources updated June 2005)

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