HealthInfo West Coast-Te Tai Poutini
Ectopic pregnancy
Hapūtanga i waho i te kōpū
An ectopic pregnancy is when an egg becomes fertilised and attaches outside of the womb. It happens in around 1 in 100 pregnancies.
Unfortunately, an ectopic pregnancy cannot survive. Because it can risk the mother's life, women who have an ectopic pregnancy often need treatment to end it. This can be a very difficult, stressful and upsetting time for the woman and her partner.
Symptoms of an ectopic pregnancy
It is common to have some mild period-like cramping and discomfort during the first trimester of pregnancy. But if you have significant pain or bleeding in early pregnancy, it is important that you contact your general practice team or LMC to find out what is causing it. These symptoms could be an ectopic pregnancy or a miscarriage.
Other symptoms of an ectopic pregnancy are pain at the tip of your shoulder, unexplained diarrhoea, fainting and dizziness.
Important
Contact your midwife, LMC or general practice team immediately or go to the Emergency Department if you:
- feel dizzy or light-headed
- are passing large clots or soaking 1 or more pads in an hour
- have tummy pain that does not get better with pain relievers or heat packs
- feel cold, shivery or unwell, or think you have a high temperature.
Diagnosing an ectopic pregnancy
A doctor will examine you and arrange for you to have an urgent ultrasound scan if they think you have an ectopic pregnancy. You may also have a blood test to look at the level of pregnancy hormone (hCG) in your blood.
The ultrasound scan will usually help show where the pregnancy is – in your womb or somewhere else. Most women just need 1 ultrasound scan to pick up an ectopic pregnancy, but some women need more scans.
Treating an ectopic pregnancy
Usually, an ectopic pregnancy is picked up early. Once you have been diagnosed with an ectopic pregnancy, you have a few treatment options depending on your situation.
Expectant management ("watch and wait")
Many ectopic pregnancies will end on their own without needing any treatment, so some women are offered an option of watching and waiting.
This option is available to women who:
- are not bleeding
- are not in pain
- have falling levels of the pregnancy hormone (hCG) in their blood (tested over 48 hours) and
- have no foetal heartbeat on their ultrasound scan.
If you are treated this way, your gynaecology team will monitor you to make sure the pregnancy is ending on its own as expected. You will need to have regular blood tests to check that your hCG levels keep falling.
Medical management
This treatment uses a medicine called methotrexate, which is toxic to dividing cells so will end the pregnancy. It is available for women who:
- are diagnosed early and are not otherwise unwell
- have a confirmed ectopic pregnancy and definitely no pregnancy in the womb
- can be available for follow-up after their treatment
- have no medical problems that mean they cannot take methotrexate.
Before being offered this treatment you are likely to have blood tests and repeated ultrasound scans over several days. If doctors recommend this treatment for you, they will give you more detailed information before the treatment starts.
Surgical treatment
If your ectopic pregnancy bursts (ruptures) and causes bleeding into your tummy (abdomen) you will need urgent surgery. You may also need surgery if the ectopic pregnancy is likely to rupture soon. Or if the diagnosis is unclear and the ultrasound scan cannot rule out an ectopic pregnancy.
Most surgery is done as keyhole surgery (laparoscopy), but some women need open surgery (laparotomy).
Most ectopic pregnancies grow in 1 of the uterine (fallopian) tubes as shown in the illustration. But they can also happen in other places.
During surgery, the pregnancy tissue is removed. The fallopian tube is usually also removed (salpingectomy). If there is a problem with the other fallopian tube, the surgeon may try to repair the tube (salpingotomy).
After an ectopic pregnancy
It is a good idea to see your general practice team 2 to 3 weeks after having an ectopic pregnancy. This is for a general check-up and to see how things are going.
Women who have had an ectopic pregnancy often feel that others dismiss their feelings of grief at the loss of their pēpi (baby). 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 you either see your general practice team or a counsellor early if you are finding it hard to cope after the loss of your pēpi.
Most women will be able to have a normal pregnancy after an ectopic pregnancy even if 1 of their fallopian tubes has been removed. It is best to have at least 1 regular period before trying to get pregnant again. If you do not want to get pregnant straight away, make sure you use contraception.
Getting help after an ectopic pregnancy
Losing a pēpi can be extremely upsetting. There are many places to get support and information.
- SANDS provides a support service for parents who have lost a pēpi. You can contact your nearest group through the SANDS website.
HealthInfo recommends the following pages
- Kiwifamilies.co.nz – Ectopic pregnancy
About ectopic pregnancy, including what to expect afterwards.
- Patient.info – Ectopic pregnancy
More detailed information about ectopic pregnancies.
Written by HealthInfo clinical advisers. Last reviewed November 2024.
Review key: HIPLT-311303
