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Ectopic pregnancy

An ectopic pregnancy is when an egg becomes fertilised and attaches outside of the womb cavity. This is thought to occur in around one in 100 pregnancies. Unfortunately, it is not possible for an ectopic pregnancy to survive and, due to the potential risk to the mother's life, medical or surgical treatment is often required to end the pregnancy. This can be a very difficult, stressful and upsetting time for women and couples. The following information gives an outline of what to expect if you are diagnosed with an ectopic pregnancy.

Symptoms

If you develop pain or bleeding in early pregnancy, it is essential that you seek medical attention from a doctor. Other symptoms that could suggest an ectopic pregnancy are pain at the tip of your shoulder, difficulty passing urine, unexplained diarrhoea, or fainting and dizziness.

If you develop sudden severe abdominal pain or heavy bleeding in early pregnancy then you should go straight to the Emergency Department.

Diagnosis

You will need to be examined by a doctor and they will arrange for you to have an urgent ultrasound scan if they suspect an ectopic pregnancy. You may also have a blood sample taken to look at the level of pregnancy hormone (hCG) in your blood.

The ultrasound scan will usually help show where the pregnancy is located. Most ectopic pregnancies can be picked up with one ultrasound scan but sometimes further scans may be needed.

Management options following diagnosis of an ectopic pregnancy

Most ectopic pregnancies are identified early and treated in different ways, depending on a number of factors. The Gynaecology Team will discuss the treatment options with you.

Surgical treatment

Surgery is performed when an ectopic pregnancy ruptures causing bleeding into the abdomen. This is a medical emergency. Surgery is also considered if there is a high risk of imminent rupture or clinical concern. It can also be used as a diagnostic method when the diagnosis is unclear after the ultrasound scan.

Most surgeries are performed by laparoscopy (keyhole surgery) but in some cases open surgery is required.

Most ectopic pregnancies occur within a fallopian tube. Where possible, the pregnancy tissue is removed and the tube is repaired (salpingotomy). However, in many cases it is necessary to remove the tube altogether (salpingectomy).

The doctors will discuss the details of what is involved in the surgery with you at the time.

Expectant management ("watch and wait")

In many cases an ectopic pregnancy will end spontaneously without any treatment. If you fit the "safe" criteria for this management, then this will be offered to you as an option.

These criteria include: being clinically stable in terms of pain and having no signs of any blood loss; blood hCG levels falling over the course of 48 hours suggesting a spontaneous end of pregnancy; and an absence of a fetal heart beat on scan.

The gynaecology team will review you, and you will need to have regular blood tests to check that your hCG levels are continuing to fall.

Medical management

This treatment involves the use of a drug called Methotrexate, which is toxic to replicating cells and will therefore end an ongoing pregnancy.

Again, there are very specific criteria that need to be met in order for this to be an option.

These include: an early diagnosis and being clinically stable; a definite diagnosis of an ectopic pregnancy and no possibility of a pregnancy within the womb; the ability to be available and comply with post-treatment follow-up; and no underlying medical problems that would exclude the use of Methotrexate.

The gynaecology team will perform an assessment and discuss their findings with you. Often this involves having blood tests over the course of a few days as well as ultrasound scans. If they feel that treatment with Methotrexate is appropriate for you they will give you more detailed information at the time.

After-care

It is a good idea to see your GP two to three weeks after having an ectopic pregnancy, for a general check-up and to see how things are going.

People who have suffered an ectopic pregnancy often feel that their feelings of grief at the loss of their baby are forgotten or dismissed. The process of undergoing urgent treatment can feel very clinical and it is easy for medical teams to forget to talk to women and couples about how they are feeling. It is important to acknowledge and allow yourself to have these emotions. Make sure that you see either your GP or a counsellor early if you are finding it hard to cope after the loss of your baby.

The following New Zealand website is a access point for support: www.miscarriagesupport.org.nz/ectopic-pregnancy

This website has information and support forums: www.ectopic.org.uk

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