ECTOPIC PREGNANCY is a common, life threatening condition affecting one in 100 pregnancies. It occurs when the fertilised egg implants outside the cavity of the womb. Most ectopic pregnancies develop in the fallopian tube, the tube which connects the ovary to the womb. As the pregnancy grows it causes pain and bleeding. If it is not treated quickly enough it can rupture the tube and cause abdominal bleeding, which can lead to maternal collapse and death.

WHAT ARE THE CAUSES OF 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 in about 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 tubal implantation is not known.

WHAT ARE THE POSSIBLE OUTCOMES?

In many cases the ectopic pregnancy dies quickly and is absorbed before a period is missed or after minor symptoms or signs of pain and bleeding. In such cases ectopic pregnancy is rarely diagnosed and a miscarriage is thought to have occurred. Nothing needs to be done in these circumstances.

If the ectopic does not die, the thin wall of the tube will stretch causing pain in the lower abdomen. There may be some vaginal bleeding at this time. As the pregnancy grows the tube may rupture, causing severe abdominal bleeding, pain and collapse.

Before this happens the ectopic may be diagnosed by blood tests which show that the normal pregnancy hormones are not rising as fast as they should be.

WHAT ARE THE SYMPTOMS?

Any sexually active woman of childbearing age who has lower abdominal pain might be suspected of having an ectopic pregnancy until proved otherwise. The pain may have begun suddenly and there may or may not have been vaginal bleeding. Most cases present between the 4th and 10th week of pregnancy with any of the following symptoms :-

• One-sided abdominal pain

  This can be persistent and sever, but may not be on the side of the ectopic.

• Shoulder-tip pain

  This may occur due to internal bleeding irritating the diaphram.

• Pregnancy test

  This may be positive but not always. Specialised blood tests are sometimes required to confirm this.

• Abnormal bleeding

  The woman may not know she is pregnant and may be experiencing an unusual period. she may have a coil fitted. The bleeding may be heavier or lighter than usual and prolonged. Unlike a period, this bleeding is dark and watery, sometimes described as looking like “prune juice”.

• A missed or late period

  A pregnancy may be suspected and pregnancy symptoms experienced e.g. nausea, painful breasts or a swollen abdomen but no bleeding.

• Bladder or Bowel Problems

  Pain when moving bowels or on going to the toilet.

• Collapse

  You may be feeling light-headed or faint, and often this is accompanied by a feeling of something being very wrong. Other signs such as paleness, increasing pulse rate, sickness, diarrhoea and falling blood pressure may also be present.