Usually, once an egg has been fertilized, it remains in the fallopian tube for around 12-24 hours before being gently swept (by hair-like follicles) towards the uterus. There are some amazing videos on YouTube documenting this. Once landing in the uterus, the fertilised egg will remain housed there until labour and birth.
If the fertilised egg does not travel all the way to the uterus, this is known as an ectopic pregnancy and causes complications. By far, the most common place an ectopic pregnancy occurs is in the fallopian tube, which happens in approximately 95% of cases. Other (uncommon) sites an ectopic pregnancy can occur are the entrance to the uterus (2.5%) and the remainder are in the ovary, cervix and abdominal cavity. There is one reported case of a 32-week-old baby surviving just outside of the uterus!
The causes vary from woman to woman and each individual pregnancy, but sometimes it’s completely unknown or unexplained. Some of the most common causes are thought to be:
- Abnormal shaped fallopian tubes
- Inflammation and/or scarring of the fallopian tubes
- Hormonal problems/imbalances
- Genetic abnormalities
Pelvic inflammatory disease (PID) can increase the risk of ectopic pregnancy, as can inflammation from any infection. Preventing infections in general could help to reduce the risk of ectopic pregnancy too. Pain during sex, bleeding between periods or abnormal vaginal loss can indicate infection (and other abnormalities) so ensure you investigate these symptoms.
It’s extremely rare for an embryo to survive outside the uterus. If an ectopic pregnancy occurs, medical intervention almost always means the pregnancy will need to end. If the embryo were left to grow, it would be life threatening to the mother and the embryo/foetus would not survive in most cases. That said, in medicine you never say always and you never say never.
Signs and symptoms of an ectopic pregnancy
Like with all pregnancies, at first there could be no signs or symptoms, therefore the ectopic pregnancy can go unnoticed. Or it could appear to be a normal pregnancy until around four weeks (sometimes later), when pain and/or vaginal bleeding tend to be present. Although less common, an ectopic pregnancy (especially when pregnancy hasn’t been noticed or confirmed) could continue up until to week 12.
The longer the ectopic pregnancy goes on for, the more serious the impact for mum, especially if the fallopian tube ruptures.
Symptoms can include:
- Pain whilst weeing or pooing, but especially when pooing
- Bloated, swollen stomach
- Cramp or pain on one side
- Pain in one or both shoulders (‘referred’ pain due to abdominal pressure)
- Nausea and vomiting
- Feeling faint
- Vaginal bleeding
Effects on mum
If an ectopic pregnancy has started to develop there could be a ‘rupture’ in the area in which the embryo is growing due to lack of space.
If diagnosed and treated early the outcome is often very positive for mums. In some cases there can be permanent damage – most commonly to the fallopian tube.
Looking after yourself if you’ve had an ectopic pregnancy
- Depending on the surgery you needed and the gestation of the pregnancy, it may take some time to heal and recover. It may also take time for you to process what happened.
- If you have had an ectopic pregnancy, the risk of it happening again is slightly higher at around 10% so it’s important to be vigilant, but also try not to focus on this too much. I have looked after many mums that have had an ectopic and gone on to have a healthy baby.
- According to the NHS, around 65% of women do have a healthy pregnancy within 18 months after an ectopic pregnancy.
- The risk variables will be different for everyone, depending on their history. If you had damage or removal of a fallopian tube due to ectopic pregnancy, you still have a good chance of becoming pregnant again. You may want to discuss optimising your chances with a fertility expert.
- It’s advisable to wait at least two months before trying for another baby. Perhaps more if you have had significant blood loss or further complications.
- If you were treated with Methotrexate, it’s advisable to wait at least three months before trying to become pregnant again. This is because the medication could be harmful to the subsequent pregnancy.