In a normal pregnancy, the fertilised egg implants and develops in the uterus. In most ectopic pregnancies, the egg settles in the fallopian tubes. This is why ectopic pregnancies are commonly called “tubal pregnancies.” The egg also can implant in the ovary, abdomen, or the cervix, so you also might hear these referred to as cervical or abdominal pregnancies.

None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the foetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth.

Ectopic pregnancy is a potentially life-threatening condition and requires prompt treatment. It usually is discovered by the eighth week of pregnancy.

What are the signs and symptoms of an ectopic pregnancy?

Common symptoms of an ectopic pregnancy include:

• Vaginal bleeding
• Signs of early pregnancy
• Lower abdominal or pelvic pain
• Dizziness or weakness
• Low back pain

If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause fainting, low blood pressure, shoulder pain, and rectal pressure. Sudden lower abdominal pain can be sharp. Contact your gynaecologist if you have any of the above symptoms.

If you realise that you are pregnant and have an IUD (intrauterine device for contraception) in place, or have a history of a tubal ligation (having your tubes tied by surgery or at the time of a C-section), contact your gynaecologist right away, as ectopic pregnancies are more common in these situations.

What are the causes of an ectopic pregnancy?

In most cases, an ectopic pregnancy is caused by conditions that slow down or block the movement of the egg down the fallopian tube and into the uterus. Certain risk factors exist for ectopic pregnancy. A risk factor is a trait or behaviour that increases a person’s chance of developing a disease or predisposes a person to a certain condition. Risk factors for ectopic pregnancy include:

• Being over age 35
• Smoking
• Use of an intrauterine device (IUD), a form of birth control, at the time of conception
• History of pelvic inflammatory disease (PID)
• Sexually-transmitted diseases such as chlamydia and gonorrhoea
• Congenital (present at birth) abnormality of the fallopian tube
• History of pelvic surgery - scarring might block the fertilized egg from leaving the fallopian tube.
• History of ectopic pregnancy
• Tubal ligation (surgical sterilisation), unsuccessful tubal ligation, or reversal of tubal ligation
• Use of fertility drugs
• Infertility treatments such as in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT)

Diagnosis of an ectopic pregnancy

If you experience severe pain in the lower abdomen or heavy-vaginal bleeding, you should immediately consult a gynaecologist. Ectopic pregnancy is detected on the basis of pelvic examination, ultrasound scan reports, culdocentesis, urine-pregnancy test, and blood tests like determination of changes in the pregnancy hormones (human chorionic gonadotropin/hCG), hematocrit, and white-blood cell count. The tests like D and C, laparotomy, and laparoscopy are done for the confirmation of tubal pregnancy.

Treatment of an ectopic pregnancy

In some cases, medicine might be used to stop the growth of pregnancy tissue.

If there is a ruptured fallopian tube, emergency surgery might be necessary to stop the bleeding. A laparotomy (a procedure during which an incision is made in the abdomen and the embryonic tissue is removed) might be needed if the embryo is large or blood loss is considered life-threatening. Laparoscopic surgery (minimally invasive surgery) might be appropriate if the fallopian tube is not ruptured and the pregnancy has not progressed very far. In some cases, the fallopian tube and ovary might be damaged and have to be removed, depending on the progression of the pregnancy.

Most women who have had an ectopic pregnancy can go on to have subsequent normal pregnancies and births. A future successful pregnancy will depend on why the first ectopic pregnancy occurred, the age of the woman and if the woman already had children. Discuss the timing of your next pregnancy with your gynaecologist.