What is an Ectopic Pregnancy?

Below is the transcription of the above video on ectopic pregnancy.

My name is Dr Peter England. I am an Obstetrician and Gynaecologist in the inner Melbourne area. Today I wanted to spend  a few minutes talking to you about ectopic pregnancy.

What is an ectopic pregnancy?

That’s a pregnancy that occurs outside the uterus. Nearly always this is in the fallopian tube either the left or right side, but occasionally in rare circumstances it can be on the ovary or the pregnancy can embed somewhere on the floor or walls of the pelvis.

How common is an ectopic pregnancy?

About 1 in 100 pregnancies is an ectopic pregnancy. It is generally a random event so any woman who falls pregnant is at risk of this common situation. However, there are a few things in your history that might increase your risk. If you are known in the past to have pelvic inflammatory disease from a condition like chlamydia, a common enough STD, that can increase your risk of an ectopic pregnancy. Likewise, serious appendicitis with inflammation and illness at the time can cause scarring at the fallopian tubes. Any other pelvic inflammatory or abdominal condition of that nature can also increase your risk.

How do you know if you’ve got an ectopic pregnancy?

Basically you will get both pain and bleeding at around 5-6 weeks, though it can present a little bit later. You will have a positive pregnancy test obviously, and when I see someone in this scenario, I carefully examine the tummy to see if there is any tenderness. The next thing I will do is a vaginal ultrasound and what I am looking for is the presence of a pregnancy sac within the uterus. And usually you can see a gestation sac in the uterus by 5 weeks. You won’t see a heart beat until the earliest at around 6 weeks. But you can usually tell certainly by that stage if the pregnancy is developing in the uterus.

If we have an empty uterus then we have to be suspicious of an ectopic and sometimes we might see swelling in the tube at either side of the uterus. Sometimes it is not clear, and I will refer you for an expert tertiary gynaecological ultrasound to get further information.

If we decided you have an ectopic pregnancy or we suspect one, what do we do?

We get some blood tests done to measure the level of pregnancy hormone level in your body. And often these blood tests are performed a couple of days apart if you are otherwise well, giving us a clue as to whether the pregnancy is failing, or whether it is growing still.

Sometimes ectopic pregnancies can resolve themselves, what’s called a tubal miscarriage, and we see the HCG levels gradually fall. It’s very important to track them down to zero because sometimes the level can begin to fall and then start to rebound.

However, often we need to do surgery typically if you have got significant pain and tenderness and we know there’s an ectopic pregnancy, you will have laparoscopic surgery because it’s very dangerous to neglect that situation. If the HCG level is significantly high, say above 2,000 units and is rising, or there is a presence of a large mass in the tube, then again surgery is indicated. The kind of surgery we do usually is keyhole or laparoscopic surgery and it does involve removing the fallopian tube with the effected pregnancy. There was a vogue in the1980’s and 1990’s with the ‘advent of’ keyhole surgery to try conservative surgery. What we realised after studies of large numbers of those cases, is it did not improve a woman’s fertility going forward, but left the already damaged tube behind posed a high risk of another ectopic pregnancy in that tube.

There is a small group of women who we can manage slightly differently, and that’s with a single injection of a drug called methotrexate. These women tend to be very stable with no tenderness, minimal pain and lowish levels of human pregnancy hormone level that are not falling on serial measurement. We would give a single injection and then track the hormone level twice a week until it falls to zero. If the hormone level begins to rise, then surgery is indicated.

If you have lost a fallopian tube to an ectopic pregnancy or any other complication, what are your chances of falling pregnant going forward?

If the other tube is healthy and all other factors being equal, the chance of pregnancy in the next 12 months is around 50-55%. That compares with a woman with two healthy fallopian tubes of around 85% pregnancy rates within 12 months.

Finally when you do fall pregnant again, it’s very important that we check carefully for an ectopic pregnancy. If you have had one ectopic pregnancy in the left tube, then the chance later on in life of getting an ectopic pregnancy in the right tube is approximately 10 %.

If you think you have an ectopic pregnancy, seek medical attention.

To book an appointment to discuss your pregnancy, please call the rooms.