ECTOPIC PREGNANCY
What is an ectopic pregnancy?
In a normal pregnancy the embryo (early pregnancy tissue) grows in the uterus (or womb).
In an ectopic pregnancy the embryo grows outside of the uterus. Most of the time, an ectopic pregnancy grows in the fallopian tube. Less often it can be on the ovary, cervix or in the abdomen. Ectopic pregnancy is rare and happens about 2 times out of every 100 pregnancies. It is usually found in the rst 5 to 10 weeks of the pregnancy. An ectopic pregnancy is not a normal pregnancy and the early pregnancy tissue growing outside of the uterus cannot become a baby.
An ectopic pregnancy can be dangerous and can cause severe bleeding, pain and even death if it is not discovered and treated quickly.
Why does ectopic pregnancy happen?
Most of the time, an ectopic pregnancy happens by chance but some women have a higher risk for an ectopic pregnancy. Known risk factors for a pregnancy outside of the uterus are:
• A previous ectopic pregnancy
• Smoking
• Infertility treatments such as IVF
• Sexually transmitted infections (STI)
• Presence of intrauterine device (IUD)
• Surgeries or scarring in the abdomen
• If you are older than 40 when you get pregnant
What happens now?
Your doctor will want to make sure that the pregnancy is outside of your uterus before starting any treatment.
You will need a blood test to check your pregnancy hormone beta-HCG and an ultrasound to see how big the tissue is and where it is. This will help guide your treatment options.
Why do you need to check my blood type?
It is very important to check your blood type to determine if you are Rh-positive or Rh-negative. Most people have Rh-positive blood. Rh is a protein that can be found on red blood cells. If you are Rh-positive, your blood cells have this protein. If you are Rh-negative, you do not have this protein. The blood type you have is determined by your genetics. Because babies have genes from their mother and father, the baby might have a different blood type than their mother.
If you have Rh-positive blood: you do not need any treatment.
If you have Rh-negative blood: it is important for you to get a shot called “RhoGam” or “WinRho” as soon as possible. This is because your baby might have Rh-positive blood and your body can develop antibodies to your baby’s blood. If you have antibodies to the Rh protein, this can lead to very serious complications for any new pregnancies. This shot will prevent your body from possibly making Rh antibodies.
What are my treatment options?
There are 3 possible treatment options for an ectopic pregnancy:
• Expectant management (or “wait and see”)
• Medication
• Surgery
The size and location of the pregnancy tissue and the level of your pregnancy hormone (beta-HCG) may decide which treatment you can safely choose.
I don’t want surgery or medication. What should I expect if I “wait and see”?
Most women will not be able to safely choose this option. If your doctor feels that you can safely ‘wait and see’, you will need at least weekly blood tests to watch your pregnancy hormone go down until it gets to zero. Depending on how high your pregnancy hormone is to start, this may take several weeks. If the pregnancy levels do not go down, you might need medication or surgery.
There is a risk that the ectopic pregnancy could rupture and cause severe bleeding during the time that you are waiting.
If you have severe pain or feel unwell, go to the closest emergency department right away. This can be a sign that the pregnancy has burst and you may need urgent surgery.
I was told that I could take medications. What should I expect?
It is important to know that not every woman will be able to safely choose this option. This depends on the size of the pregnancy tissue, the level of the pregnancy hormone and the presence of symptoms such as pain.
If you treat with medication, you will be given a shot called methotrexate. This medication causes the pregnancy tissue to stop growing. After getting the shot, you will need blood tests to watch your pregnancy hormone go down to zero. It is very important that you do the blood tests at the right times. If your levels do not go down as expected, you might need another shot or surgery. Side effects of methotrexate include mild abdominal pain, vaginal bleeding, nausea (feeling sick to your stomach), vomiting, diarrhea, and very rarely, hair loss. After you have the medication, you should stop any prenatal vitamins or folic acid. They can make the medication not work as well. You should also stop having sex until your pregnancy hormone is zero.
There is still a risk that your ectopic pregnancy could rupture and cause severe bleeding while you are waiting for the pregnancy hormone to get to zero.
If you have severe pain or feel unwell, go to the closest emergency department immediately. This can be a sign that the pregnancy has burst and you may need urgent surgery.
I was told that I need to have surgery. What should I expect?
You will need surgery if:
• The pregnancy tissue is large
• The pregnancy hormone levels are high
• There are signs of internal bleeding
• You are in too much pain or are unwell
• You have had an ectopic pregnancy in the same place before
The surgery for an ectopic pregnancy is usually done through very small ‘key-hole’ incisions (laparoscopically). Once inside the belly, the surgeon will take out the pregnancy tissue and stop any internal bleeding. This surgery is done in the operating room while you are completely asleep. If the pregnancy is in the fallopian tube, this procedure is called laparoscopic salpingostomy (removal of the pregnancy tissue from the tube) or salpingectomy (removal of the tube).
Once you are in the operating room:
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You will be given a general anesthetic. This means that you will be asleep the entire surgery.
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A tube will be placed in your throat to help you breathe.
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A catheter will be placed in your bladder. Depending on your surgery, it might be removed at the end of the procedure or the next day.
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Your doctor will make a small 1 cm cut at your belly button or just under the left side of your rib cage. The laparoscope (a long camera) is then inserted through this cut.
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During the procedure, the abdomen is lled with carbon dioxide gas to let your doctor see your organs more clearly.
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Your doctor will make 2 to 3 more small (5 mm) cuts to insert instruments to perform the surgery. Sometimes an instrument is placed through the vagina into the cervix to move the uterus and help your doctor see your organs.
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Once the surgery is completed, all the instruments are removed.
The small cuts are closed with stitches or tape. There will be small scars that will usually fade over time.
The major risks of surgery are:
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Excessive bleeding
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Infection
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Injury to the surrounding organs (bowel, bladder, ureters, nerves, blood vessels in the pelvis)
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Having to make a larger incision on the abdomen (this is done if the procedure cannot be safely completed using the small key-hole instruments)
Can I get pregnant again?
Yes - the chances of a normal, healthy pregnancy after an ectopic pregnancy are very good. About 65% of women are pregnant within 18 months of having an ectopic pregnancy. Your chances of getting pregnant will depend on the health of your fallopian tubes and any scar tissue in your pelvis. If you have trouble getting pregnant again, see your doctor to do more testing and to see if any fertility treatments are needed.
When you get pregnant again, it is important to see your doctor right away. Your risk of another ectopic pregnancy is higher because you have had one in the past. You will need an early ultrasound to make sure that your next pregnancy is in the right place (in the uterus, and not another ectopic).
How long do I have to wait before trying again?
If you have been treated with methotrexate, you should wait 3 months from when you were given the medication before you get pregnant. Once your pregnancy hormone level reaches zero, start prenatal vitamins or folic acid before you try to get pregnant.
If you have had surgery, you should wait until you get your period before you try. This will help to date the next pregnancy.
If you don’t want to get pregnant right away, it is important that you talk to your doctor about a birth control method that is right for you.
I am very sad and upset. Is this normal?
The loss of any pregnancy, at any time, can be very upsetting. A range of emotions are normal. These can include fear, sadness, grief, self-doubt or guilt, shock and denial. People react differently to this news, including how intensely they feel and for how long.
Where can I get more help or information?
If you are having difficulty coping or feel that you would like to have some support, contact your family doctor. There are also many organizations that you can contact to get more help or more information:
Pregnancy & Infant Loss Network
pailnetwork@sunnybrook.ca
T. 416.480.5330 or 1.844.772.9388
Bereaved Families of Ontario
Toronto, ON
bfotoronto.ca
T. 416.440.0290 or 1.800.236.6364
The Ectopic Pregnancy Trust
ectopic.org.uk
Miscarriage Association UK
miscarriageassociation.org.uk
Sunnybrook Health Sciences Centre
2075 Bayview Avenue Toronto, ON M4N 3M5
Telephone: 416.480.6100
PR xxxxx (Feb 2017)
