Understanding the signs of ectopic pregnancy

Remember that butterfly-in-the-tummy feeling when you first saw those two pink lines? For many women, the joy of a positive pregnancy test can quickly turn into worry if they suspect an ectopic pregnancy.

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An ectopic pregnancy is a fear that many expectant mothers may have, but thankfully it is uncommon. Ectopic pregnancies occur in around 1-2 per cent of pregnancies in Australia.

The actual causes and symptoms aren’t always known, but there are some things to be aware of.

What is an ectopic pregnancy?

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An ectopic pregnancy, also called tubal pregnancy, is when a fertilised egg implants outside of the uterus, most commonly in the fallopian tube.

Imagine a delicate seed, a tiny embryo, trying to grow in a place that isn’t meant for it. In a normal pregnancy, the fertilised egg travels safely to the uterus, where it can nestle and grow. But, in this instance, the egg gets lost and tries to take root in the fallopian tube, which isn’t designed to support a growing baby.

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Several factors can cause, or increase the risk of, an ectopic pregnancy.

Fallopian tube damage:

Previous pelvic infections, endometriosis, or pelvic surgery can damage the fallopian tube, making it more difficult for a fertilised egg to travel to the uterus causing egg implants in the fallopian tube itself.

History of ectopic pregnancy:

If you have experienced an ectopic pregnancy before, it is important to be vigilant during future pregnancies as the risk of having another one is higher.

Fertility treatments:

Women undergoing fertility treatments, such as In Vitro Fertilisation (IVF) may have a slightly higher risk of ectopic pregnancy.

Other risk factors:

Other risk factors include smoking, age over 35, and sexually transmitted infections (STIs).

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How will I know if I am having an ectopic pregnancy?

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Symptoms can be hard to come by but typically appear around week 4-12 of pregnancy. The earlier it is diagnosed, the easier it will be to save the tube and prevent serious bleeding and damage.

Ectopic pregnancy can be a distressing and confusing experience, especially if you are a first-time mum. It’s normal to feel overwhelmed and unsure of what’s happening while navigating a whole new world of sensations and changes.

Whilst aches and pains are normal, they can create some anxiety for you. If you are wondering whether you might be experiencing an ectopic pregnancy, here are the key symptoms to watch out for.

Symptoms of ectopic pregnancy

• Serious pain on one side of the abdomen.
• Severe waves of pain in your neck, shoulder, abdomen, or pelvis.
• Vaginal bleeding or spotting– usually in a dark red colour and often doesn’t last the length of a normal period.
• Diarrhea and vomiting/ bowel pain.

When does ectopic pregnancy pain start?

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Early ectopic pregnancy pain can start at any time during the first trimester, but it’s most common between 4 to 8 weeks after fertilisation.

Some women may experience pain as early as 4-5 weeks after their last menstrual period. However, for most women, evident symptoms of an ectopic pregnancy begin between 6 and 8 weeks with severe pain in the abdomen or pelvic area.

In rare cases, symptoms may not appear until later in the first trimester.

Differentiating pregnancy pain

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While both ectopic and normal pregnancy can cause discomfort, there are some things you need to look out for:

Location: Ectopic pregnancy causes severe abdominal pain almost always localised to one side. In a normal pregnancy, discomfort can be more generalised, affecting the lower back, hips, or breasts.

Intensity: Pain in ectopic pregnancy can be severe, sharp, or even stabbing in the abdominal cavity, often accompanied by unusual vaginal bleeding and other symptoms. Typical pregnancy discomfort is typically milder and may seem more like soreness.

Frequency of occurrence: Ectopic pregnancy pain may be persistent or intermittent, compared to discomfort that often comes and goes in normal pregnancy.

Other symptoms: If your symptoms go beyond fatigue, nausea, and frequent urination, it may be worth looking into. Ectopic pregnancy may be accompanied by vaginal bleeding, shoulder pain, lightheadedness, or fainting.

How can it be diagnosed?

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If you’re concerned that something might be a bit off, trust your instincts and get in touch with a healthcare provider. Your doctor will want to take a close look and run some tests to see if everything is okay.

The tests may include:

Pregnancy test: It involves blood tests to measure the pregnancy hormone levels ( hCG).

Pelvic exam: A pelvic examination to check for areas of tenderness, pain in your abdomen or a mass in the fallopian tube.

Transvaginal ultrasound: This non-invasive test uses sound waves to create images of your internal organs, including your uterus and fallopian tubes.

Transabdominal ultrasound: If a transvaginal ultrasound is inconclusive, a transabdominal ultrasound may be performed.

These procedures allow your doctor to see inside the body without any pain or discomfort. How cool is that? Bless the advancement in tech.

In some cases, additional tests may be necessary, such as:

Laparoscopic surgery: Also known as keyhole surgery, it is a minimally invasive surgical procedure that allows your doctor to visualise your reproductive organs.

Culdocentesis: A procedure in which a needle is inserted through the vagina into the space behind your uterus to collect fluids for testing.

What is the treatment of ectopic pregnancy?

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If you find out you have an ectopic pregnancy, your doctor will talk to you about the best way to handle it. They’ll consider the severity of the condition and your general health to decide on the best course of action.

Here are the main treatment options for ectopic pregnancy:

Expectant management: In some cases, if the ectopic pregnancy is small and not causing any symptoms, your doctor may recommend monitoring it closely to see if it resolves on its own. This is known as expectant management.

Medication: A medication called Methotrexate can sometimes be used to treat an ectopic pregnancy. Methotrexate will stop the development of the egg by helping to dissolve the growing tissue and reduce the risk of ruptured ectopic pregnancy.

Surgery: If the egg has developed past the stage where it will die naturally, surgery might be required to protect the fallopian tube from getting damaged.

There are two main types of surgery used to treat ectopic pregnancy:

• Laparoscopy: This minimally invasive procedure involves making a small incision in the abdomen. It uses a camera and surgical instruments to remove the ectopic pregnancy.
• Laparotomy: This is a more traditional kind of surgery that involves making a larger incision in your abdomen.

Can I prevent it?

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Unfortunately, an ectopic pregnancy is not usually preventable or predictable. While it is not always possible to completely prevent ectopic pregnancy, there are certain factors within your control that can help reduce your risk:

Factors within your control:

• Regular prenatal care: Stay on top of your prenatal care. Regular check-ins with your doctor can help catch an early ectopic pregnancy.
• Treat sexually transmitted infections (STIs): Untreated STIs, such as chlamydia and gonorrhoea, can increase the risk of ectopic pregnancy.
• Avoid smoking: Smoking can damage the fallopian tubes, increasing a woman’s risk of ectopic pregnancy.
• Limit alcohol consumption: Excessive alcohol consumption can also increase the risk of ectopic pregnancy.

Factors beyond your control:

• Age: Pregnant women over the age of 35 are at a slightly higher risk.
• History of ectopic pregnancy: If you have had a previous ectopic pregnancy, future pregnancies may have a higher risk of being tubal pregnancy.
• Damaged fallopian tube: Previous pelvic infections, endometriosis or surgeries can damage the fallopian tubes.

Whilst many pains, aches, and worries come with pregnancy, it’s always important to listen to your body and if you’re concerned about anything, speak with your doctor or midwife.

Frequently asked questions

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1. What are the early signs of ectopic pregnancy?
   Early signs include pelvic pain, vaginal bleeding, accompanied with shoulder pain, lightheadedness, or fainting spells.
2. Is internal bleeding a risk with ectopic pregnancy?
   Yes, there is a risk of internal bleeding in the instance of a ruptured ectopic pregnancy, which typically means that the fallopian tube becomes weakened or damaged due to the pressure induced by the growing embryo on the fallopian tube. If not treated promptly, internal bleeding from an ectopic pregnancy can be life-threatening.
3. When do most unresolved ectopic pregnancies end?
   It usually ruptures after 6 to 16 weeks causing pregnancy loss. When this occurs it can lead to severe bleeding which can be life-threatening. The later the rupture, the greater the risk of substantial blood loss and risks.
4. Can ectopic pregnancy pain be mistaken for something else?
   Yes, it can sometimes be mistaken for other conditions, such as appendicitis, kidney stones, ovarian cyst rupture, or endometriosis.
5. What should I do if I suspect ectopic pregnancy pain? Are there any preventive measures for ectopic pregnancy?
   If you suspect ectopic pregnancy, it is important to seek medical care immediately. Early diagnosis and treatment can help prevent serious complications.

Sources

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Better Health Channel, Ectopic pregnancy, April 2014

The Royal Women’s Hospital, Ectopic pregnancy, n.d

Mayo Clinic, Ectopic pregnancy, March 2022