Ectopic Pregnancy

A pregnancy that does not occur in the uterus (womb) is called an ectopic.

Usually, an ectopic occurs within the fallopian tube however, ectopics may occur in other sites such as the ovary, the cervix, the junction of the uterus and the tubes, and much more rarely ,even within the peritoneal cavity. 

Ectopics presenting in an area other than the fallopian tube can be much larger and if they rupture, are much more dangerous ,with many litres of blood loss into the abdominal cavity.

The incidence of ectopic pregnancy is about 1% of all pregnancies.  With the IVF technologies, the incidence of tubal ectopic was initially increased because of  the egg and sperm being put down the fallopian tubes together.  Now that we put embryos directly back into the uterine cavity, the incidence of ectopic is much lower.

Symptoms of ectopic pregnancy include but are not limited to severe crampy pain in the pelvis, an abnormal menstrual history, missed period, pain with intercourse, and almost always, a positive pregnancy test. Sometimes a patient will present as a medical emergency, and they are still a cause of maternal death, even in Australia.

Although occasionally ectopic pregnancy may be “seen” on ultrasound scan, ultrasound should only be used to show that the pregnancy is not in the uterus.  If no pregnancy sac is seen by 6 weeks since the last period, and the patient has a positive pregnancy test, pain and bleeding, an ectopic should be suspected.  Most ectopic pregnancies can now be removed laparoscopically.