Ectopic pregnancy

What is an ectopic pregnancy?

An ectopic pregnancy is when a fertilised egg does not 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

What can increase my chances of having an ectopic pregnancy?

About 1 in every 100 pregnancies is an ectopic pregnancy.

Many women who have ectopic pregnancies do not 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
• 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
• smoking
• being 35 years of age or older

How is an ectopic pregnancy diagnosed?

Your doctor will ask about your symptoms and do an examination. 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.

You will need to have follow-up tests after your treatment to make sure that the pregnancy has completely 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 recommend 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

During watch and wait treatment, you should go to the nearest emergency department or call triple zero (000) for an ambulance if you develop 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, which 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 recommended if you are bleeding internally or are at risk of bleeding. Surgery may also be needed if medication is not a suitable option.

If surgery is recommended, it is usually done as keyhole surgery.

In some cases, your doctor may need to do open surgery or remove your fallopian tube.

What support is available?

Ectopic pregnancy is a kind of early pregnancy loss. It is normal to feel grief, so remember that 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 arrange this for you. There are also community support groups — see below.

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

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 is partly because the underlying cause may still be there, and partly because 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 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?

It's recommended you wait the following times before getting pregnant again:

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

This is because methotrexate takes a long time to completely 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 recommend you have an early pregnancy ultrasound. This is to make sure that the pregnancy is in your uterus.

Resources and support

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

SANDS Australia provides support for people who have had a miscarriage, stillbirth or newborn death. You can call their Bereavement Support Line 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.

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