The EPT

What are the symptoms of a deteriorating ectopic pregnancy?

To be able to answer this you first need to know what the symptoms of an ectopic pregnancy are, and unfortunately the condition is notoriously difficult to diagnose. The following symptoms might be seen in a stable ectopic pregnancy.

One-sided pain in your tummy

This can be persistent and severe or intermittent, which means it can come and go.

Bladder or Bowel Problems

Feeling pain when you have your bowels open or when you pass water are commonly reported signs in ectopic pregnancy.

Bleeding in pregnancy

Bleeding is often dark and ‘prune juice’ like, but some women report spotting and bleeding of redder blood. Bleeding in early pregnancy is thought to occur in about 30% of all pregnancies, of which only 1 to 2% will be ectopic.

Feeling pregnant or knowing you are pregnant but really feeling that something is very wrong.

If your instincts are screaming at you that something doesn’t feel right, it’s OK to trust them.

However the reality is that bleeding, some pain and a change in your normal bladder and bowel pattern are features of a normal pregnancy for some women. All the same, if you present at your GP or hospital Early Pregnancy Unit with such symptoms, it would be reasonable to have an early pregnancy assessment.

Things your doctor will consider

Early pregnancy assessment usually involves an ultrasound scan. If at this point a pregnancy can be seen - that is a pregnancy sac, with halo, a foetal pole and a beating heart - then the chance of a coexisting ectopic pregnancy, whilst possible, is very slim. In a case like this, bleeding may be unexplained and continue, the pain related to a normal healthy corpus luteum cyst which forms on the ovary after ovulation and can swell to cause pain. The change to the bowel and bladder may be attributed to the hormonal changes causing the woman to want to pass urine (pee) more often and possibly even be a little constipated (find it hard to open the bowels to have a poo).

If you continue to bleed, the most likely outcome would be miscarriage rather than ectopic pregnancy. However a percentage of women continue to spot and bleed throughout their pregnancy without losing their babies so bleeding does not automatically mean pregnancy loss.

If signs of pregnancy can be seen in the uterus but not yet a viable foetus, the doctors will want to rescan you, usually in a week’s time and blood will normally be taken to establish the level of hCG in the blood stream and again 48 hours later, to see how the levels are behaving.

If no pregnancy can be seen in the uterus,  the doctors will want to rescan you, usually in a week’s time and blood will normally be taken to establish the level of hCG in the blood stream and again 48 hours later, to see how the levels are behaving.

In both these cases, you will be diagnosed with a pregnancy of unknown location (PUL). This is the point at which the doctor will be relying on you to be vigilant.

Deciding whether your symptoms are getting worse

Trying to decide whether your symptoms are getting worse can be really tricky, but as a general rule, if you aren’t sure something is wrong then you are probably OK to wait for half an hour and continue to make your own assessment. The difficulty is, often when we feel worried about our pregnancies and no one can be precise about a diagnosis and there isn’t a doctor on hand to ask, stress can really cause us to become very concerned and confused.

Probably the single most useful thing to do, if you aren’t sure if things are getting worse, is to take yourself in to a quiet space, sit or lie and relax by breathing in deeply and out again in the same way, two or three times with your eyes shut and then ask yourself the question, ‘right here, right now, am I OK?’ If the reply you get back is “yes I am OK” or “mmm I am not sure” then you should give yourself half an hour of relaxation and quiet time, take paracetamol for the pain, as directed on the pack if you have any, and then reassess yourself in half an hour.

When considering pain, it can be helpful to give yourself a pain scale, with zero being no pain at all and ten, the worst pain you have ever had in your life multiplied by ten. Give yourself a score. Women often report pain up to a seven on their own personal pain scale in normal pregnancy. The way to test if this is OK pain would be to take two paracetamol as directed on the pack, (please remember to take no more than two tablets every four hours and no more than 4 doses in 24 hours) then rescore the pain about 45 minutes later. If the pain has eased at all, then it’s unlikely that the pain you have is related to a deteriorating ectopic pregnancy.

Shoulder tip pain is also a sign of a deteriorating ectopic pregnancy. Unfortunately, when we are worried and stressed, its normal to hold our posture differently, tensing muscles you perhaps wouldn’t normally tense, which can cause discomfort and pain in the neck and shoulders. The relaxation exercise should help you to determine the difference between stressed muscles and genuine shoulder tip pain. Shoulder tip pain is actually a fairly unique pain. Shoulder tip pain is usually caused by internal bleeding irritating the diaphragm when you breathe in and out. It is exactly where it says – not the neck or the back but the tip of your shoulder. If you look to the left over your shoulder and then cast your eyes down, the tip of your shoulder is where your shoulder ends and your arm starts.

Shoulders cause pain when we are stressed because we hold our selves more rigidly, and muscles in the back and neck go in to spasm – this is not shoulder tip pain.

Shoulder tip pain is very distinctive and you know when you have it because it is a very ‘weird’ pain you have never had in your life before (unless you had pain of this nature with gall stones or liver problems).

And finally you should be aware of a change in the bleeding you are experiencing. If this becomes very heavy, causing you to soak a pad in less than an hour, or if you soak a pad in two hours with this level of flow continuing for more than 4 hours, you should have this checked out.

So deciding if your ectopic pregnancy is deteriorating can be difficult but if your bleeding increases, your pain becomes more intense and you can’t manage it with over the counter pain relief, you develop pain in the tip of a shoulder and you become very dizzy and lightheaded, you should be reassessed urgently.

Remember you can always call NHS Direct for information and advice on 111 contact your out of hours GP service or your normal surgery, or contact the hospital who is assessing you for advice. If you have any doubts or concerns you should ask your doctors for a reassessment at any time.