• Reference Number: HEY-578/2022
• Departments: Gynaecology
• Last Updated: 1 May 2022

Introduction

This leaflet has been produced to give you general information about an ectopic pregnancy.  Most of your questions should be answered by this leaflet.   It is not intended to replace the discussion between you and your doctor but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy outside the uterus (womb). Normally, after the sperm and egg meet in the fallopian tube, the fertilised embryo travels into the uterus to allow pregnancy growth and development. If the travel is interrupted for whatever reason, a pregnancy will start to grow within the fallopian tube. In this situation a pregnancy cannot survive as it will quickly run out of space to grow and at the same time will pose a serious risk to you should the rupture (burst) of fallopian tube happen, as this can lead to internal bleeding.

Rarely an ectopic pregnancy can occur in places other than a fallopian tube, such as ovary, cervix, abdomen.

In the UK, one in 90 (just over 1%) of pregnancies is an ectopic pregnancy.

What is pregnancy of unknown location?

A pregnancy of unknown location (PUL) is a type of ectopic pregnancy which means that you have a positive pregnancy test but there is no pregnancy inside or outside of the womb, identified on an ultrasound scan or by a laparoscopy.

We will monitor you by taking blood samples to measure your pregnancy hormone levels. Depending on the result and your symptoms we may suggest repeating the blood tests or plan treatment.

Why does an ectopic pregnancy happen?

The cause is not always known but may follow damage to the fallopian tube after an infection or previous surgery or may be associated with the use of some forms of contraception (intrauterine coil).

What are the risk factors for an ectopic pregnancy?

Any woman of childbearing age who is having sex could have an ectopic pregnancy. However, the following can increase this risk:

•  Previous ectopic pregnancy
•  Pelvic infection, pelvic inflammatory disease (PID). There may be a history of infection in the tubes (e.g. Chlamydia), however sometimes you may not of ever been aware of having the infection.
• Previous abdominal and pelvic surgery (including sterilisation)
•  Intrauterine devices (coils), progesterone-only pill (mini pill)
•  IVF (in vitro fertilisation) techniques
•  You are over 40 years of age
•  Smoking

How is an ectopic pregnancy diagnosed?

If an ectopic pregnancy is suspected by your doctor, you should attend the hospital. An ultrasound scan and a pregnancy test will be completed. If the scan shows an empty uterus but the pregnancy test is positive, an ectopic pregnancy is possible, although an intrauterine pregnancy may be too early to see on scan, or a miscarriage might have occurred. Even with an internal vaginal scan it is not always possible to see an ectopic pregnancy on a scan.

If you are well and not in severe pain, you may have a blood pregnancy hormone test (Beta human chorionic gonadotropin), repeated every 48 hours, until the diagnosis is clear.

In some instances, there is no evidence of either pregnancy in the uterus or in the tubes, if this is associated with consistently positive pregnancy tests this is called pregnancy of unknown location. What is important to know about this condition is that it will not lead to viable (live) pregnancy and could pose a risk to your health. The doctor at the hospital will discuss treatment options with you.

If there is a high suspicion of a ruptured ectopic pregnancy, the first diagnostic test may be surgery (either key-hole or open) to inspect your tubes and the pelvis. The doctor at the hospital will explain if you need an operation.

How is ectopic pregnancy treated?

This will depend on many factors, symptoms you presented with, levels of pregnancy hormones (hCG), scan results and your own preferences.

Sometimes, when levels of pregnancy hormone (hCG) are low and you do not have any symptoms, it may be appropriate to carefully watch levels of pregnancy hormone (hCG) if they are coming down.

There is also a medication, called methotrexate, available to treat ectopic pregnancy or pregnancy of unknown location.

If there is a high suspicion of a ruptured ectopic pregnancy, or you develop worsening symptoms, a laparoscopy (keyhole surgery) to inspect the tubes and your pelvis will be done. Sometimes, if severe internal bleeding occurs, open surgery (laparotomy) is performed. The doctor will explain if you need an operation.

You may also find useful leaflets on medical management of an ectopic pregnancy or a pregnancy of unknown location and surgical management of an ectopic pregnancy. 

If you need to have surgery, you will be asked to sign a consent form and advised of any risks and complications. The doctor will discuss the operation with you.  A nurse or doctor will complete a consent form regarding fetal remains.

Fetal remains if you have surgery for ectopic pregnancy:

Sometimes this option will not be available straight away following surgery as most of the time the possible ectopic pregnancy will need to go for histology, to check it was an ectopic pregnancy. Once the histology has been performed you can still have all the below choices.

These are the choices available to you:

1. The hospital will arrange a shared cremation with your consent; this is carried out at the crematorium in a sensitive and respectful manner.  If you would like details of when this will happen this information can be given to you.

1. However, if you wish to have an individual cremation / burial you may of course make your own arrangements, but the hospital is unable to contribute to the costs.

1. If you are unsure of your wishes, you can contact the hospital within 4 weeks of your procedure.

1. In all cases the staff will ensure that your cultural and religious beliefs are respected.

1. You are also legally allowed to take your pregnancy remains home to bury yourself.  There are certain legal requirements that must be adhered to if you wish to do this, which are as follows:

• The burial must not cause any danger to others.
• It must not interfere with any rights other people may have on the land.
• There must be no danger to water supplies or watercourses.
• There must be no chance of bodily fluids leaking onto adjoining land.
• The remains must be buried to a depth of at least 18 inches (45cm).
• Permission must be obtained from the landowner if you do not own the land.
• Careful thought needs to be given when considering burial in a garden, taking into account what would happen if you chose to move.

Your next pregnancy

Before trying for another baby, you should allow yourself time to recover both physically and mentally.

In your next pregnancy you should contact Early Pregnancy Assessment Unit (EPAU) / Ward 30 as soon as you think you are pregnant. This is so you can have an early pregnancy scan at six weeks, to check that the pregnancy is in the right place this time. The overall risk of another ectopic pregnancy is between 7 to 10%.

Your emotions

An ectopic pregnancy can be a devastating experience. Your feelings may vary enormously in the weeks and months following your loss. You may feel relieved to be free from pain and out of danger, but also grieve the loss of your baby.  Due to the seriousness of your condition, you may also have the feelings that everything has been rushed – tests, scans, treatment and that there has been little time to adjust. You may be wondering why this has happened to you.  All these feelings are perfectly normal. 

It may be helpful to know that the possibility of a normal pregnancy next time is much greater than the possibility of having another ectopic pregnancy. 

Your partner’s emotions

An ectopic pregnancy can put a great strain on your relationship. The experience may bring you together, but you might find that your partner seems unable to understand your feelings or respond to your needs.

You and your partner may feel differently about what has happened. Their main concern may be for you, especially if your life has been threatened by the ectopic pregnancy and they have felt powerless and unable to help. They may have hidden their own grief in order to be supportive towards you. It is important to share your thoughts so misunderstanding does not happen and you both can get through this difficult time.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the:

 Early Pregnancy Assessment Unit/Emergency Gynaecology Unit, Women and Children’s Hospital  –  (01482) 608767

Gynaecology Ward – Ward 30, Women and Children’s Hospital  – (01482) 604387

Useful contacts and websites

The Ectopic Pregnancy Trust
Phone Helpline                                                                020 77332653
PO Box 485
Potters Bar
EN6 9FE
www.ectopic.org.uk

Miscarriage Association                                          01924 200799
(Monday to Friday 9am to 4pm)
C/o Clayton Hospital, Northgate, Wakefield
West Yorkshire WF1 3JS
www.miscarriageassociation.org.uk

Information on Gynaecology Services at Hull University Teaching Hospitals NHS Trust can be found at: https://www.hey.nhs.uk/content/services/gynaecology

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.