Ectopic pregnancy

An ectopic pregnancy occurs when a fertilised ovum nests outside the mucous membrane of the uterine cavity. The incidence of ectopic pregnancy is put at 0.5% to 2% of all pregnancies; unfortunately, the risk of recurrence increases tenfold. It is ectopic pregnancies that often lead to damage and, in extreme cases, rupture and the need for surgical removal of the fallopian tube, with the consequent reduction or loss of the chance of natural conception. 

What is an ectopic pregnancy?

In a normal pregnancy, the embryo implanted inside the uterine cavity. Sometimes, however, the embryo may implant outside the uterine cavity, in which case we speak of an ectopic or ectopic pregnancy (ectopia - displacement in Latin). Most commonly (in 97%), ectopic pregnancies are localised in one of the fallopian tubes, but locations on the ovary, in the cervix and even on the intestines or abdominal wall are also encountered.

Make an appointment for a consultation at Invimed If you have undergone an ectopic pregnancy, make an appointment for an initial infertility consultation at Invimed. Our specialists will know how they can help you achieve your dream of having a baby. They can order appropriate treatment and tests - including an assessment of the patency of your fallopian tubes. Make an appointment

What are the symptoms of ectopic pregnancy?

In the early stages, ectopic pregnancy has no characteristic symptoms (apart from typical pregnancy symptoms), hence the difficulty in its early diagnosis. As the pregnancy grows, the symptoms are related to the location of the pregnancy. 

In the most common fallopian tube pregnancy, non-specific lower abdominal pains begin to appear around the 6th-7th week, which escalate to a condition known as 'acute abdomen' and are accompanied by dizziness and fainting - symptoms associated with bleeding from the fallopian tube into the abdominal cavity, peritoneal irritation and blood loss. There is also often spotting from the genital tract, prompting the pregnant woman to have an early gynaecological check-up.

How is an ectopic pregnancy diagnosed?

The basis of diagnosis is an ultrasound examination, but in the early stages of 4-5 weeks an ectopic pregnancy may not be visible or may give an uncharacteristic image on examination. Rising pregnancy hormone (hCG) levels, with an empty uterine cavity, directs suspicion to an ectopic location of the pregnancy. The finding of a gestational follicle structure with a visible embryo outside the uterine cavity provides certainty and confirms the primary diagnosis.

The pregnancy test (hCG test) alone can never detect or differentiate ectopic pregnancy. In the initial period, when we follow the rate of increase of hCG from the moment of expected implantation, poor growth rates of chorionic gonadotropin (hCG) can suggest abnormal implantation, but also many other pathologies of the gestational follicle itself. Only the combination of ultrasound and hCG testing allows a more precise diagnosis. 

What causes a pregnancy to locate outside the uterus?

More often than not, the embryo gets stuck in its journey through the fallopian tube, from the place where fertilisation took place, towards the uterine cavity within an obstruction of some kind.

These may be minor adhesions in the fallopian tube, diverticula or damage to the structure of the fallopian tube. These lesions are either congenital or result from inflammation within the adnexa (especially caused by chlamydia trachomatis or after complicated appendicitis), with the presence of small foci of endometriosis or after pelvic surgery. Adhesions both compressing the fallopian tube from outside and inside are the most common cause of embryo retention and implantation in an abnormal location.

Excessive uterine contraction activity can also lead to the embryo moving back into the fallopian tube or into the cervix. 

What are the effects of ectopic pregnancy on a woman's fertility?

The effects of ectopic pregnancy on fertility depend on:

• the location of the pregnancy follicle,
• date of detection of pregnancy,
• treatment modality. 

Removal of fallopian tubes

Some time ago, the standard after the diagnosis of ectopic fallopian tube pregnancy was surgery combined with the removal of the entire fallopian tube together with the pregnancy follicle, but it should be noted that ectopic pregnancies themselves were detected in very advanced stages and the operation was usually a life-saving procedure for the patient due to severe haemorrhage into the abdominal cavity. In the situation of removal of the fallopian tube, fertility was limited by 50% due to alternate ovulation once from the right and once from the left ovary.

Sparing treatment

Currently, we try to diagnose the pregnancy as early as possible, when sparing treatment (e.g. in a laparoscopic procedure, removal of the fetal egg itself from the fallopian tube) or even pharmacological treatment with cytostatic drugs is still possible.

With conservative treatment, the impact on fertility is much less, but the increased risk of recurrence of the pathology must be borne in mind.

Consultation at an infertility clinic

It is always advisable to assess the patency of the remaining fallopian tube or fallopian tubes (if both remain) after the ectopic pregnancy has been treated. If an HSG or sonoHSG examination shows abnormalities, a consultation at an infertility clinic is indicated. However, such a consultation should always be carried out after a second ectopic pregnancy, especially if both fallopian tubes are involved, regardless of the treatment.

To arrange a consultation, call 500 900 888.

Ectopic pregnancy and in vitro

If both fallopian tubes are obstructed or missing, the only chance of having a child is through in vitro fertilisation treatment - IVF.

The risk of ectopic pregnancy in an IVF procedure is constant at around 0.8%, regardless of the number of ectopic pregnancies in the past. The transfer of the embryo into the uterine cavity is carried out under ultrasound guidance - the embryo is always administered to the most optimal location within the uterine cavity.

From the administration of the embryo to the moment of implantation, a period of 24 to 96 hours elapses, depending on the stage of development of the transferred embryo. The strong uterine contractions that occur during this period can lead to the embryo being displaced outside the uterine cavity.

Post-transfer recommendations

If excessive uterine contractile function assessed, e.g. by the UMA test, is found in preparation for transfer, intravenous tocolytic (inhibiting myometrial contractions) or diastolic or sedative drugs may be used in the peri-transfer period.

However, lifestyle recommendations will always remain fundamental - avoiding heavy physical exertion, avoiding stress and prohibiting intercourse, i.e. avoiding all those situations that can trigger or exacerbate uterine contractions.

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Article elaborated: Dr Robert Gizler, gynaecologist-obstetrician, medical director of the Invimed clinic in Wrocław. Graduate of the Medical University of Wrocław. Member of the Polish Gynaecological Society (PTG), the Polish Society of Reproductive Medicine and Embryology (PTMRiE) and the European Society of Human Reproduction and Embryology (ESHRE).