Ectopic Pregnancy

What is an ectopic pregnancy?

An ectopic pregnancy occurs when a fertilised egg grows outside of the womb (uterus), most commonly in the fallopian tube. In rare cases, it can happen in the ovary, cervix, or previous caesarean section scar. A pregnancy cannot continue normally if it is an ectopic pregnancy.

How common is it?
Out of every 1,000 pregnancies, about five to seven are ectopic pregnancies.

What causes an ectopic pregnancy?
In a normal pregnancy, the fertilised egg travels through the tubes into the womb to grow. In a tubal ectopic pregnancy (pregnancy in the fallopian tube), the fertilised egg gets stuck in the fallopian tube and starts growing there. This may be caused by:

• Scarring or damage to the fallopian tubes from past infections or surgeries
• Abnormal tube shape
• Unknown reasons

What are the risks factors of ectopic pregnancy?
You are more likely to have an ectopic pregnancy if you have:

• Had a previous ectopic pregnancy
• Pelvic infections (e.g. pelvic inflammatory disease or sexually transmitted infections)
• Previous fallopian tube surgery or sterilisation
• Used an intrauterine contraceptive device (IUCD)
• Had In-Vitro Fertilization (IVF) treatment
• Smoked tobacco

What are the symptoms?
Some women may have:

• Irregular or light vaginal bleeding
• Lower abdominal or pelvic pain (often on one side)
• Pregnancy symptoms such as breast tenderness or nausea

However, some women may not have any symptoms. If you miss your period and have risk factors of ectopic pregnancy, see a doctor early.

What are the complications of ectopic pregnancy?
An ectopic pregnancy can rupture the fallopian tube and cause heavy internal bleeding. This is a medical emergency. Your life may be at risk if the bleeding is severe.

Seek immediate medical help if you have:

• Sudden, severe abdominal or pelvic pain
• Feeling faint or dizzy
• Pain in your shoulder tip

How is an ectopic pregnancy diagnosed?
A pregnancy test is done first, followed by an ultrasound scan to check for a pregnancy in the womb. If no pregnancy is seen in the womb, your doctor may advise for:

• Additional blood tests (to measure pregnancy hormone levels)
• Repeat scans
• A key-hole (laparoscopic) surgery

Sometimes, it is difficult to diagnose an ectopic pregnancy in its early stages and you may require a few follow up appointments with blood tests and ultrasound scans.

Treatment options for ectopic pregnancy

1. Surgery
   A keyhole surgery, known as laparoscopy, is performed under general anaesthesia to remove the ectopic pregnancy. Surgery is required if:
   
   
   • The ectopic pregnancy has ruptured
   • The ectopic pregnancy is large in size with high pregnancy hormone levels
   • The ectopic pregnancy has a fetus with a heartbeat (live ectopic pregnancy)
     
     
   An open surgery (laparotomy) may be required in emergency cases when there is severe and massive bleeding.
   
   The removal of the fallopian tube together with the ectopic pregnancy is usually recommended. You can still get pregnant if the other tube is healthy.
   
   However, if the other fallopian tube is abnormal, your doctor may discuss the options of removing the ectopic pregnancy alone while keeping the fallopian tube. In this case, additional blood tests, injections or even a second surgery may be required subsequently.
   
   
2. Methotrexate injection
   If diagnosed early and you are stable, a medication called methotrexate may be given to stop the pregnancy from growing. You will need blood tests for monitoring. Please refer to the patient information leaflet on “Methotrexate for management of ectopic pregnancy and pregnancy of unknown location”.
   
   
3. Conservative management (Wait and See)
   If your pregnancy hormone levels are already dropping and you are stable, your doctor may monitor you closely without immediate treatment. You will still be followed-up closely with repeat blood tests until the pregnancy hormone levels become normal.
   
   If you had received methotrexate or no treatment, there remains a risk of rupture of the ectopic pregnancy, and you will need to seek immediate medical help if you experience any sudden severe abdominal or pelvic pain.

Trying to conceive again after an ectopic pregnancy

• After a surgical treatment (laparoscopy or laparotomy): you can try after your next menstrual period.
• After methotrexate injection: you would be advised to wait for three (3) months before trying to conceive again.

You may have a slightly higher risk of another ectopic pregnancy, so you should see a doctor early in the next pregnancy.

Where should I seek help?
You can seek immediate medical attention at the Urgent O&G Centre, Basement 1, Women’s tower KKH any time.

If your symptoms are mild, you can call for a same day appointment at the Early Pregnancy Assessment Unit (EPAU):
Central appointments: 6294 – 4050
Alternative line: 6394-1199

The information above is also available for download in pdf format.