Causes & Symptoms | Treatments | Post Treatment | The Future | Terminology

Causes & Symptoms

 

NB Terms marked with an asterisk * are explained in the terminology section at the end of the FAQs.

What are the causes of an ectopic pregnancy?

The fertilised egg normally spends 4-5 days travelling down the tube from the ovary to the cavity of the womb where it implants, usually 6-7 days after fertilisation. The most common reason for an ectopic pregnancy is damage to the fallopian tube, causing a blockage or narrowing. There could also be a problem with the walls of the tube, which should normally contract and waft the fertilised egg into the womb. Conditions such as appendicitis or pelvic infection can damage the tube by causing kinks or adhesions, thus delaying the passage of the egg, allowing it to implant in the tube. In most cases, however, the cause of the ectopic is not known.

What are the symptoms?

• Abdominal pain. Can be persistent and severe. The pain may just be on one side, but not necessarily on the side of the ectopic
• Shoulder-tip pain
• Abnormal bleeding. The bleeding may be heavier or lighter than usual and prolonged. Unlike a period, this bleeding is often dark and watery, sometimes described as looking like 'prune juice'
  A missed or late period
• Bladder or bowel problems. Pain when opening the bowels or passing urine
• Pregnancy Test (urine). This may be positive but is not always the case. If you feel pregnant the absence of a positive pregnancy test doesn’t mean you might not have an ectopic pregnancy.
• Sickness and diarrhoea. Often confused with gastroenteritis.
• Collapse. You may be feeling light-headed or faint, and often this is accompanied by a feeling of something being very wrong.
  

Who is at risk of an ectopic pregnancy?

Any sexually active woman of childbearing age has a risk of an ectopic pregnancy. However, ectopic pregnancies are more likely if you:

• have had Pelvic Inflammatory disease
• have had Endometriosis
• have had any previous abdominal surgery (including caesarean section)
• have had a coil fitted
• are on the progesterone-only contraceptive pill (mini pill)

or if you are a:

• daughter or granddaughter of a woman who was treated with a drug in the 50s, 60s and 70s called DES (diethylstilboestrol) for miscarriage.

Some studies also suggest that:

• Women over the age of 35
• Women who smoke tobacco
• Women who use Cannabis

are all at an increased risk of ectopic pregnancy, but in some cases more research needs to be undertaken to establish these risks.

 

Where in the body does ectopic pregnancy occur?

• The fallopian tube
• The ovary
• The cornua or inserstitial part of the uterus
• The abdomen
• The cervix
• The scar of a cesarean section

 

How are ectopic pregnancies diagnosed?

Ectopic pregnancy can be notoriously difficult to diagnose as it can often present with symptoms which can be suggestive of gastroenteritis, miscarriage or even appendicitis. However, If you suspect that you, or someone else, are suffering from an ectopic pregnancy then read here to find out what the symptoms are. In the first place you should go to your doctor and explain to him/her the symptoms.
If someone is suspected of suffering with ectopic pregnancy it would be usual to perform an ultrasound scan and to follow up with beta hCG* blood tests 48 hours apart if the scan is inconclusive. The doctors will be looking for your hCG levels to double or increase by at least 66% in that time. These tests can help doctors to assess how the pregnancy is progressing, even if your urine pregnancy test (standard G.P. or chemist urine test) is not positive or has stopped being positive.

 

At what stage in pregnancy are ectopic pregnancies most likely to occur?

Ectopic pregnancies commonly cause symptoms between the sixth and seventh week of pregnancy which usually leads women to seek help at this time. However, the parameters appear to be as wide as between the 4th and 16th week of pregnancy for a tubal ectopic pregnancy, and in some cases longer for ectopic pregnancies located in other sites.

 

Do I ovulate while having an ectopic?

Ovulation usually resumes when hCG levels* decrease below 100 IU/l. Therefore it is not unusual to diagnose ovulation when an ectopic pregnancy is in state of resolution following expectant or medical treatment.

 

Could the level of exercise I did contribute to my ectopic?

Don't worry if you do lots of intense cycling and spinning or other kind of exercise. Exercise and sport in general, makes no contribution to ectopic pregnancy.

 

Can flying cause ectopic pregnancy?

There is no evidence to link ectopic pregnancy to flying.

 

Does having a miscarriage make me more at risk of ectopic pregnancy?

No, this does not appear to be the case.

Does having an ectopic pregnancy make me more at risk of Miscarriage?

No, this does not appear to be the case.

Unfortunately, a fairly large proportion of women who are diagnosed and/or treated for an ectopic pregnancy, will statistically also experience a miscarriage at some point. This sad event, should it occur, rarely fails to beg the question in the mother, “Is this related to my ectopic pregnancy?” There is no research based evidence to suggest that there is any direct link between the two kinds of pregnancy loss.

Some researchers have suggested the following likely causes for miscarriage. The total percentage does not add up to 100% as the ranges quoted are from different studies that do not necessarily agree with each other but are thought among clinicians to be the most likely causes of miscarriage.

Chromosome abnormality 50%e.g. autosomal trisomies (22.3 percent), monosomy X (8.6 percent), triploidy (7.7 percent) and tetraploidy (2.6 percent)

Hormonal conditions 20%
e.g. Endocrine disorders, Hyperprolactinemia, Diabetes Mellitus, Thyroid disorders etc

Blood and immunological disorders 10-13%
e.g. Antiphospholipid Syndrome, Systemic Lupus Erythematosus etc

Abnormal anatomy 5-10%
e.g. Fibroids, bicornuate uterus, etc, often referred to as Mullerian anomalies

Infection 1% - 10%
e.g. Including most commonly, active sexually transmitted infections (STI) or damage caused to the reproductive organs by a previous STI or other pelvic infection

It has been estimated that approximately two-thirds of human conceptions (fertilised oocyte) fail to achieve viability and an estimated 50 percent are lost before the first missed menstrual period.
The ever-increasing sensitivity and accuracy of over-the-counter home pregnancy testing kits, means that women often detect a pregnancy very early, and often before the first day of their missed period. However, statistically, a significant number of these early pregnancies will sadly not result in successful pregnancies for the mother, but end in miscarriage.

Approximately 12 to 15 percent of clinically confirmed pregnancies (a gestational sac seen on an ultrasound scan, in the uterus) are lost within the first 12 weeks of pregnancy. This is referred to as a first trimester loss.

Once a heartbeat has been seen on an ultrasound scan, the risk of first trimester loss reduces to around 4% (JL Deaton, 1997)

Is it possible to remove the baby from the tube and put it into the womb?

Although this has been tried, it has never been done successfully. Because the egg has implanted in the wrong place, often the baby isn't able to grow properly and to try and transplant what has grown, sadly, wouldn't result in a baby.

Treatments

1. Non-invasive treatments. Methotrexate and expectant management.

At what stage in pregnancy can I have methotrexate?

Methotrexate* is most effective in the earlier stages of pregnancy, usually when the hCG level is below 3000. The risk of rupture is higher in pregnancies with levels greater than this. However, in cornual ectopic pregnancy it is not unusual to try to treat with higher levels. With ectopic pregnancy*, it is not really the stage of pregnancy (as in the number of weeks gestation), but the size of the ectopic, which can vary over the first few weeks depending on the rate of growth, that is important. For a more detailed understanding of when Methotrexate might be considered, both this protocol and the Greentop Guideline 21 might be helpful. More information about methotrexate can be found on our message forums.

 

How long should I expect to bleed after methotrexate?

The response of women to treatment with methotrexate varies greatly. The bleeding is from the lining of the womb and is hormonally controlled. It will probably last a week or two, changing in colour from red to brown and diminishing. As long as it is not too heavy, and is not associated with pain, you should not worry. Some women report bleeding and spotting for up to six weeks. You can find a more detailed description of what to expect after treatment with Methotrexate here

 

What happens when you have the shot of Methotrexate? Does the baby stay in the tube or does it get expelled? How will I feel?

In an ectopic, there is often a pregnancy sac, but most often a foetus or baby as we'd know it, is not developing. What Methotrexate does is prevent the trophoblast cells from dividing. Trophoblast cells are the invading cells of the pregnancy and those that form the afterbirth or placenta. It is these that rupture the tube, cause the pain and have the potential to cause internal bleeding to the mother. Once these cells no longer divide, the pregnancy is ended and the whole pregnancy sac, including any cells that might eventually have grown into a baby, is usually reabsorbed by the mother. This is normal and happens in many cases of miscarriage. You may feel pain after being given methotrexate but this is due to the pregnancy sac swelling and not due to effects on the baby. The tube, however, may remain blocked by the pregnancy tissue which can take some time to shrink. Occasionally it may not shrink and will leave a blockage in the tube, by way of a small cyst. However, the use of Methotrexate does not reduce the chances of successful future pregnancy, whatever the outcome in the affected tube.

Women sometimes find treatment with Methotrexate quite a long and drawn out process. This can feel frustrating but the outcome is often very successful and it is worth persevering with the wait involved for the hCG levels to drop, and the repeated blood tests, until that happens.

 

Why are my doctors doing nothing except take my blood?

Where the levels of hCG are low and the woman has no severe symptoms of ectopic pregnancy, your doctors may make a decision to treat you 'expectantly'. Expectant management is increasingly common. It means that the patient is observed closely and the pregnancy given the opportunity to resolve without treatment, which is possible when hCG levels are low.

Being managed with no treatment can feel quite scary but your doctors are giving your body the best chance to resolve this naturally without having to give you powerful drugs or invasive surgery. This method of management is successful in up to 50% of patients with low levels, which is why doctors will sometimes be willing to try it.

 

2. Surgical treatments

What operations are done for ectopic pregnancy?

Operations for ectopic pregnancy are performed increasingly by keyhole surgery but when this is not possible the procedure is extended to a major abdominal operation called a Laparotomy*. Once the surgeon can see the ectopic pregnancy s/he will try to perform the least invasive surgery possible.

This will usually be a partial or total salpingectomy* (removal of the part or the whole of the fallopian tube) or in some cases, they may try to perform tubal surgery, avoiding loss of the tube, though this is increasingly rare. Examples of these include a salpingostomy*, where the tube is cut lengthways and the ectopic tissue removed from the hole and the tube then carefully stitched back together, or a procedure called frimbrial expression, where the ectopic tissue is gently massaged through the tube. However the most usual method is to remove the affected part or all of the tube.

 

How long should I expect to bleed after surgery?

Women’s responses vary greatly after surgery. You might bleed for a few days or continue to spot and bleed for up to 6 weeks. So long as you aren't soaking a pad in less than an hour and the bleeding gradually tails off, it is considered broadly normal. However, if you have concerns you should consult your doctor, health care provider or NHS Direct.

 

Why can't I find information on twin or 'Heterotopic' pregnancy?

Heterotopic pregnancy is the term used to describe a condition where there is the co-existence of an intrauterine pregnancy with an ectopic pregnancy.

People who do suffer a heterotopic pregnancy often worry that there is very little written about the condition or its management, but this is largely because the condition is treated no differently to a singleton ectopic pregnancy. Medical treatment where Methotrexate is used is not a suitable treatment option for heterotopic pregnancy because it would adversely affect the co-existing intrauterine twin. Expectant management, which is where the woman is observed but no invasive treatment is undertaken, and surgery, are the treatments of choice.

In heterotopic pregnancy it is possible for the co-existing intrauterine twin to survive, which happens in around 30% of diagnosed cases of heterotopic pregnancy, despite the woman being treated surgically for the condition.

It is very difficult to be specific about the incidence or rarity of heterotopic pregnancy and differing figures can be found when you research in to the condition, for example: 1 in 4000and 1 in 8000 (1).However, other researchers have determined heterotopic pregnancy incidence to be between 0.6-2.5:10,000 pregnancies (2).Therefore, it is very difficult to say categorically the actual incidence of heterotopic pregnancy.

We do know that there is a significant increase in the incidence of heterotopic pregnancy in women undergoing ovulation induction. An even greater incidence of heterotopic pregnancy is reported in pregnancies following assisted reproduction techniques such as In Vitro Fertilisation (IVF) and Gamete Intra-Fallopian Transfer (GIFT), where more than one embryo is transferred. Heterotopic pregnancy is thought to be higher among some ethnicities. In indigenous women in Nigeria, for example, there are 45 twin pairs per 1000 births. This contrasts with 10–12 pairs per 1000 births in white European women and 5 pairs per 1000 births in women from some Far East Asian countries. Thus it follows that the incidence of heterotopic pregnancy is higher among Nigerian women than among Far East Asian women. (3)

And so in conclusion, we know that naturally occurring heterotopic pregnancy remains rare and is treated in much the same way as singleton ectopic pregnancy, which is why so little can be found about its treatment and management.

(1) Hann, Bachman, & McArdle, 1984, Reece, et al., 1983, Bello, et al., 1986, van Dam, Vanderheyden, & Uyttenbroeck, 1988, Vanderheyden & van Dam, 1987.

(2) Richards SR, Stempel LE, Carlton BD: Heterotopic pregnancy: Reappraisal of incidence. Am J Obst Gynecol 142:928, 1982. Bello GV, Schonolz D, Moshirpur J, et al: Combined pregnancy: The Mount Sinai experience. Obstet Gynecol Surv 41:603, 1986.

(3) D.A. Adekanle, H. Ekomaye, P. B. Olaitan: Heterotopic Pregnancy With A Live Female Infant: A Case Report. The Internet Journal of Gynecology and Obstetrics. 2007. Volume 7 Number 1

 

Post Treatment

Should I expect any pain or discomfort after the operation and how long will it last?

Depending on which operation was done, a varying amount of pain or discomfort may continue for several weeks afterwards as the healing process continues and scarring continues to heal. This should lessen as time progresses. However, it is not unusual to still report some discomfort several months after an abdominal operation.

 

Can I take a shower and when can I have a bath following surgery?

Normally, you can shower 24 hours after an operation on your abdomen (tummy) and take a bath after 48 hours. It's a good idea to make sure someone is around when you get into the bath, in case you find it uncomfortable or tricky to get out. Don't rub or wash the scars - gentle washing in warm water with a mild soap or body wash gel, avoiding the actual scars, is all that is needed. If for some reason it's not advisable to take a bath, you will usually be told this as part of your discharge information. If you are in any doubt, ring the ward where you were discharged from and ask them. Dissolvable stitches often rely on the person taking regular baths to help the stitches dissolve.

 

For how long will I feel and look bloated? Why am I bloated?

Bloatedness is a reaction to the operation and the inflammation following this. The length of time it continues varies, but it should settle within 6 weeks. If it continues for longer it may be a sign that you have some ongoing infection and you should see your GP.

 

Is it normal to still have sore breasts a few weeks after my operation?

You may get sore breasts immediately after and for some weeks after the operation as they get used to not being pregnant. They may get sore again leading up to the next period.

 

Is there likely to be scar tissue and will this affect my future chances?

After any abdominal operation there is some scar tissue. The abdominal scars should make no difference to your future chances. The tube that was operated on may have been removed, or at least damaged from the operation, but pregnancy is usually achieved through the other tube anyway, irrespective of whether or not the tube was salvaged. Sometimes adhesions form in the abdomen as a result of surgery and these can sometimes compromise the remaining tube, but only time will tell. Even so, overall, 65% of women are pregnant again within 18 months of an ectopic pregnancy and some studies suggest more women are pregnant after 2 years, taking some estimates to around 85% of women over 2 years.

 

Other people had their blood monitored since leaving hospital. Should I?

If you are treated medically with Methotrexate or if you had your tube salvaged, you need to have your blood monitored as the risk of persistent ectopic is greater. If you had your tube removed the risk is low and blood testing is not normally necessary, although some doctors do check it once either prior to the woman leaving hospital, or after a week or so to make sure levels are dropping.

 

Do I need a check up with my GP, practice nurse or hospital after my ectopic?

Not really. It is useful to check around 6 weeks to make sure all is well and that your periods are starting again. Many hospitals offer a follow up appointment but some do not. If you haven't been given a follow up appointment at the hospital your GP can do a post operative checkup for you, but as long as you feel OK, there is no real medical need to see a doctor. You may find it beneficial to talk through what happened with a medical professional, and this is the most usual reason for wanting to see a doctor at this stage.

 

I'm really tired all the time. Is this normal and how long should it take to feel myself again?

Some people take longer to recover than others. It depends on how much blood you lost and what operation you had. The bigger the operation and the more blood lost, the longer it takes to feel yourself again. Usually you should be fully recovered physically by 6 weeks, but in some people it may take longer. As long as you are making progress, you should not worry.

Methotrexate can also leave you feeling quite exhausted in the first early days of treatment and you should take things gently, at a slower pace, until your energy levels return.

 

When can I start to do exercise?

This depends on how you were treated and, if you had an operation, the type of surgery you had. If you had keyhole surgery, you could start gentle exercise within 2 weeks of the operation. If you had open surgery then you should wait 6 weeks for your abdomen to heal. If you were treated with Methotrexate you shouldn't resume exercise until your hCG levels are falling consistently and are in the low 100's. Exercise like swimming is usually safe, as long as the wounds are healing or your hCG levels are low, as this is a non-impact sport.

 

Will I be safe to drive?

Depending upon the type of surgery you had you are very likely to be advised not to drive. The length of time you are advised not to drive for will depend upon the surgery you had. You will also need to check with your insurers when they consider it safe for you to drive after the more major procedure of laparotomy because different brokers’ and underwriters’ policies vary. Driving isn't prohibited after medical treatment with methotrexate or expectant management but you should feel comfortable to be able to do an emergency stop before you take control of any vehicle.

 

When can I return to work?

This depends on the way you were treated and what type of work you do. In some cases you could return to work with a few weeks if you had keyhole surgery and your job is not too strenuous, but you may feel tired and find it difficult to cope. Coming back part-time, if this is an option, may be a good idea. Women treated with Methotrexate sometimes work through the treatment but others find managing the loss of a baby in this way too difficult to work through. In general, after 6 weeks you should be able to return to most jobs from a physical point of view, but some women take more time off to help them deal with the psychological impact of their loss.

 

Can an ectopic pregnancy affect menstruation and subsequent menopause?

There is no evidence that an ectopic pregnancy affects menstrual periods or changes the timing of menopause. However, women often report an irregularity in their cycle following an ectopic pregnancy and, if it was necessary to undertake surgery on the ovary or remove one of the ovaries, this can result in menopause developing slightly earlier. However, the impact does not appear to be significant.

 

When can I expect a period after my ectopic and will it be painful?

Your periods can take a while to re-establish and they can re-start anything between 2 and 10 weeks after surgery, or once hCG levels have fallen below about 100mIU/mL. It’s a waiting game really.

Most women find that their period arrives sometime around week 6 or 7 after surgery, and at some time in the 4 weeks after their hCG levels have fallen to 0 if treated with Methotrexate.

The first period may be more painful or less so than usual, heavier or lighter, last for longer or shorter than usual - there really is no set pattern. You should be able to manage the discomfort with over-the-counter pain relief and should not be soaking a pad in less than an hour. If this is not the case, you should seek medical attention. Your periods may be a little irregular or erratic but broadly speaking, doctors consider periods of between 23 to 42 days to be within normal parameters. If the first day of your last period was more than 42 days ago, make an appointment with your doctor to discuss the possible reasons for this.

Following surgery, we usually advise you wait for 2 of these cycles before trying to conceive again, to allow your body to heal and your emotions to surface and be dealt with. In the case of treatment with Methotrexate, we advise you to wait for at least 3 months after the last injection and if you had two injections some doctors suggest 6 months.

 

Will I still have a period every month after removal of one of my tubes?

You will continue to have normal periods every month. A period is the shedding of the lining of the womb. The presence of the tubes makes no difference to this. Periods continue even if both tubes have been removed. In fact, periods usually continue normally even in the very rare cases when one of the ovaries is removed as part of the surgical process.

 

Will my periods return to the normal after my ectopic - before they were 25/26 days - this time I'm 30 days (I've checked I'm not pregnant) is this alright?

The first period can occur up to 6 weeks after the ectopic pregnancy although it may not be like your normal period. It might be heavier or lighter and it may be more painful than normal. The period after that is usually more like your normal pattern. However, although there is no medical reason for it, women do often report some irregularity to their cycle for several months after an ectopic pregnancy.

 

Is it normal to have pain during ovulation after my ectopic?

After surgery for an ectopic pregnancy you may have some adhesions which might cause some pelvic pain and pain at ovulation but this usually settles.

 

What exactly do ovulation kits predict?

The predictor kit measures the hormone LH. A surge in LH leads to ovulation within the next 12 hours. The egg doesn't always get released from the ovary in spite of a surge but it is a very good marker. A positive pregnancy test around 14 days after you think ovulation occurred is the only way of establishing that it actually did. If a doctor has referred you for follicular tracking, your ovulation might be observed with ultrasound scans, but this is only done once other tests have indicated there might be a problem with ovulation. You are likely to be expected to try to conceive for around 12 months before you would be referred for testing, as the majority of women would have conceived within this time frame if they were actively trying.

The Future

Are there any tests I can have done to ensure I won't have another ectopic pregnancy?

The only tests of any real value are performed after a period of trying to conceive without success. If after a year of trying you are not pregnant (or six months if you are over the age of 35) you should visit your health care provider to discuss that. They might consider blood tests to establish evidence of ovulation and possibly a referral for a Hysterosalpingogram test (HSG). Many women wonder why this test isn't offered immediately after an ectopic pregnancy but the HSG* test is only usually performed after a period of trying to conceive without success, and most doctors won't consider it until you have been trying for 12 months. This is because, depending upon which sources you read, the risk of infection could possibly outweigh the potential help the test could offer you in the form of a diagnosis in the short term. If at the point of surgery there was nothing to suggest your tube(s) is/are blocked (and given that 65% of women are successfully pregnant within 18 months rising to more like 85% of women over 2 years), doctors do not want to diminish that chance by running the risk of introducing infection with a test that may not actually be of any help or use at this stage.

 

Is it likely I could have another ectopic pregnancy?

The overall chance of a repeat ectopic pregnancy, after a first, in the UK is about 10% and this depends on the type of surgery carried out and any underlying damage to the remaining tube(s). The risk rises again after subsequent ectopic pregnancies.

 

What can I do to prevent another ectopic pregnancy?

Since ectopic pregnancy is more related to past tubal damage rather than the present, there is little that can be done to prevent a future ectopic. However, if you feel that you may have ongoing problems of pelvic infection, (and it is well-known that Chlamydia trachomatis may give no symptoms) then testing and antibiotic treatment for this might help to reduce the risk of a future ectopic.

 

What are my chances of a future successful pregnancy after an ectopic pregnancy?

This very much depends on the condition of your remaining tube(s). The loss of a tube does reduce success rates, but you can still become pregnant and have a successful pregnancy with only one tube intact. Overall, 65% of women will become pregnant within 18 months after an ectopic.

 

Is it true that I ovulate on alternate sides each month?

This varies from woman to woman. Some women will ovulate from the same side each month with an occasional ovulation from the other side, while others will ovulate randomly from side to side. It depends on which ovary contains the egg that is at the right stage of development. However, it probably does not matter as an egg from one ovary can travel down the tube on the other side. In the past, the ovary on the side of the ectopic was removed as part of the operation but this is no longer carried out, as it was not found to be beneficial.

 

When is it safe to have sex again?

This depends what you mean. You could fall pregnant within 6 weeks of an ectopic pregnancy if you have unprotected intercourse and this may be before your period has even returned. Most doctors suggest that at the very least you should wait for the first normal period before you attempt to get pregnant again from a purely physical point of view and many doctors and specialists, who understand pregnancy loss as a speciality, suggest waiting for 2 proper cycles or three months, whichever is the sooner to allow the body to heal and your emotions to surface and be dealt with. Having sex is itself not dangerous to you, as long as you do not find it painful. Many doctors suggest waiting until after you have had your first proper period, which means waiting until around 6 weeks, to allow full healing of the muscles and by that time you should have had your first period, giving you confidence that your body is returning to its normal rhythm. Ultimately though, the decision about when to have sexual intercourse again is one for you and your partner and should be based on when you feel ready, which for some is earlier than 6 weeks and for others later.

 

When can I try to get pregnant again?

You could fall pregnant within 6 weeks of an ectopic pregnancy but some studies suggest that the risk of a further ectopic, if you become pregnant in the first two cycles, might be greater. The general advice is that you should wait for 2 proper cycles or three months before you attempt to get pregnant again after surgical treatment. It is especially important to wait for three months before you try again after you have been treated with one injection of Methotrexate, as this medicine can alter your metabolism and might interfere with the cells of a developing pregnancy in a negative way. If you require two injections of Methotrexate a week apart, speak with your health care providers and establish what they believe to be the safest waiting time before you try again. Some doctors suggest a 6 month wait after two separate doses, given 7 days apart, of Methotrexate.

 

Is there anything I can do to improve my chances next time?

Not really, but if you have a history of abdominal pain which persists after the ectopic, then you should see your GP to make sure you do not have a persistent infection that might contribute to a future ectopic. Then it’s a matter of healing and resuming normal activities. Having regular sexual intercourse, once every two or three days between period bleeds is a good way to approach future conception.

 

Do other people feel scared about trying again?

Yes, most people feel scared about trying again. An ectopic pregnancy is a very frightening experience in which many women thought they were going to die. Because of this, most early pregnancy units would offer early scanning in the next pregnancy to make sure that all is well.

 

Terminology

 

What is beta hCG?

The hormone beta hCG is produced by the placenta. In normal pregnancy the levels double every two days. When the level in urine is high enough, the home pregnancy test becomes positive. In ectopic pregnancy, the levels are usually lower and rise more slowly (and your pregnancy may not test positive). A combination of ultrasound findings and blood levels of hCG can make a more accurate and earlier diagnosis allowing more treatment options.

 

What is Methotrexate?

Methotrexate has proven to be a viable alternative to surgical treatment for ectopic pregnancy. If administered early in the pregnancy, methotrexate can disrupt the growth of the developing embryo by preventing the trophoblast cells (which provide nutrients to the embryo and develop into a large part of the placenta) from dividing.

 

What is a laparoscopy?

Laparoscopic surgery, also called keyhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures.

 

What is a laparotomy?

A laparotomy is a surgical procedure involving an incision through the abdominal wall to gain access into the abdominal cavity.

 

What is expectant management?

Expectant management, or watchful waiting, is an approach to a medical problem in which time is allowed to pass before further medical intervention or therapy is considered. During this time, repeated testing may be performed. Often expectant management is recommended in situations such as ectopic pregnancy, with a high likelihood of self-resolution or situations where the risks of intervention or therapy may outweigh the benefits.

What is a tubal abortion?

Tubal abortion is the term used when an ectopic pregnancy resolves itself when the products of conception separate from the wall of the fallopian tube, without the need for medical intervention.

 

What is a salpingectomy?

A salpingectomy is an operation to remove a fallopian tube.

 

What is a salpingostomy?

A salpingostomy is an operation to remove a pregnancy from the fallopian tube.

 

What is a salpingotomy?

A salpingotomy is an incision into the fallopian tube.

What is a cornual pregnancy? What is an interstitial pregnancy?

A cornual pregnancy or interstitial pregnancy is a rare type of ectopic pregnancy which occurs when the fertilised egg implants in that part of the fallopian tube buried deep in the wall of the uterus. Pregnancies of this kind are difficult to diagnose as they appear to be in the uterus on scan and are particularly dangerous as they can progress further and tend to rupture later having the potential to damage the wall of the uterus as well as the fallopian tube

 

What is a heterotopic pregnancy?

Heterotopic pregnancy is the term used to describe a condition where is the co-existence of a pregnancy in the uterus and an ectopic pregnancy. It is exceptionally rare and little additional information about the condition is available because the ectopic pregnancy needs to be treated and in some cases the uterine pregnancy continues and in other cases not. The treatment for this kind of ectopic is usually surgery

 

What is chlamydia ?

Chlamydia is a common sexually transmitted infection and is a major infectious cause of human genital and eye disease. Chlamydia can be transmitted during vaginal, anal, or oral sex, and can be passed from an infected mother to her baby during vaginal childbirth. Many people with Chlamydia exhibit no symptoms of infection. Between half and three-quarters of all women who have chlamydia have no symptoms and do not know that they are infected. If untreated, chlamydial infections can cause serious reproductive and other health problems, including ectopic pregnancy, with both short-term and long-term consequences. Chlamydia is easily treated with antibiotics.

 

What is an HSG?

A Hysterosalpingogram is an xray procedure to investigate the shape of the uterine cavity and the shape and patency of the fallopian tubes.

 

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