Ectopic pregnancy - Patient Information Brochures - Mater Health Services
An ectopic pregnancy results when an early pregnancy becomes implanted anywhere outside the cavity of the womb. It is a potentially serious condition affecting about one in 100 pregnancies. Most ectopic pregnancies develop in the fallopian tubes but some cases occur in the ovary, cervix or even the abdominal cavity. The early pregnancy cannot survive away from the protective, nourishing environment of the womb although it may continue to develop for several weeks.
As the fallopian tube is not large enough to accommodate a growing baby, the thin wall of the fallopian tube will stretch causing pain in the lower abdomen and often vaginal bleeding. If not diagnosed and treated the tube can sometimes rupture, causing severe abdominal bleeding.
Sadly there is no possibility that your pregnancy can survive. The loss of your baby is likely to make you feel very sad. In addition this may be the first time you have heard of this condition and so you may also feel shocked, confused and anxious about the future. The purpose of this leaflet is to explain fully what an ectopic pregnancy is. It is important that you understand exactly what has happened to you, and why we may recommend a certain course of action. What causes an ectopic pregnancy?
The very early pregnancy normally spends four to five days in the fallopian tube before travelling to the womb where it implants around six to seven days after fertilisation. Any damage to the fallopian tube can cause a blockage or narrowing.
Hormonal imbalance, malfunction of the uterus and tube and infection can all impair the tubes normal function and result in ectopic pregnancy. Some women are at an increased risk of an ectopic pregnancy such as those: with a history of previous ectopic pregnancy with a previous history of pelvic infection or and tubal damage with a history of infertility with previous history of pelvic surgery including sterilisation using or having previously used an IUCD (coil) undergoing assisted conception such as IVF. How is an ectopic pregnancy diagnosed?
If an ultrasound scan shows an empty uterus but the pregnancy test is positive the possibilities are that an ectopic pregnancy, a very early normal pregnancy or a miscarriage. The ectopic pregnancy may appear as a small pregnancy sac outside the womb or as a mass. However, it is not usually easy to see an ectopic pregnancy on a scan. In such cases repeated blood tests are done to measure the pregnancy hormone levels. In ectopic pregnancy the levels are usually lower and rise more slowly. Is it possible to remove the baby from the tube and put it into the womb?
Although this has been tried, it has never been done successfully. Because the egg has implanted in the wrong place, often the baby isn t able to grow properly and to try and transplant what has grown, sadly, wouldn t result in a baby. What needs to happen now?
While you are in the Mater Private Emergency Care Centre we will do a number of things to losely monitor your condition. We will regularly take your temperature, pulse and blood pressure. We will also check you regularly for pain and bleeding. Please let us know immediately if any of your symptoms worsen. We will take some blood tests and put an intravenous line in your arm. The blood tests are to check for blood loss and pregnancy hormones. We can administer pain relief through the drip. Our aim is to keep you as comfortable and pain free as possible. You will also be sent for an ultrasound.
In some cases an ectopic pregnancy is absorbed and there are minimal or no symptoms (like pain or bleeding). Nothing needs to be done in these circumstances except to ensure that the pregnancy hormone levels quickly returns to normal. Sometimes medicine is used to dissolve the early ectopic pregnancy. In some cases, bleeding can be severe and an operation is required. Your doctor who is looking after you in the Mater Private Emergency Care Centre will assess you and refer and discuss your condition with a specialist gynaecologist. The decision about what treatment you require is based on your clinical condition. What would need to happen next?
You will be referred to a gynaecologist for ongoing management. There are a number of options for treatment that will depend on your clinical condition. You may need an operation. You may require repeat blood tests for pregnancy hormone levels measured over the next week. You may also require a further scan. We will let you know the specific things that your gynaecologist requests. Please ask us if any of this information does not make sense to you. What do I need to look out for?
Please inform us of any change in your symptoms such as worsening pain or bleeding, nausea, dizziness or any other symptoms. Surgical management of ectopic pregnancies
An operation is one way of treating an ectopic pregnancy. In some circumstances this may be the only choice available to you. What is laparoscopy (keyhole surgery)?
The operation is performed under a general anaesthetic. In this procedure the surgeon usually makes three small incisions in your abdomen one inside your belly button and one or two lower incisions lower down on your abdomen. A small telescope is inserted through the hole in your belly button to allow the surgeon to see what they are doing. If an ectopic pregnancy is confirmed usually the tube is removed. Sometimes it may be possible to make a cut on the tube and remove the pregnancy leaving the tube intact. The downside of this is that sometimes not all of the pregnancy tissue is removed. Further, this tube is now damaged and there is an increased chance of another ectopic in that tube in the future. Your specialist will discuss these issues with you. What is a laparotomy (open surgery)?
This operation is very similar to a laparoscopy except that is done through a bigger cut in the skin. The cut is about eight to ten centimetres long and is usually made along the bikini line (like the cut made for a caesarean section). While most operations for ectopic pregnancy are done using keyhole surgery, sometimes an open operation needs to be performed. This is more likely if you have had a lot of bleeding and are unwell, or if the keyhole surgery is not technically possible Are there any risks?
Like all operations, small anaesthetic and surgical risks are involved. There is a very small risk (approximately one chance in every 1000 procedures) of injury to the bowel or blood vessels when entering the abdomen using keyhole surgery. In such cases, we would usually change to performing open surgery. There is a very small risk of infection, although this is slightly higher if an open procedure is performed.
Sometimes you have had a lot of bleeding or there may be bleeding during the procedure. If you are very unwell from this blood loss we may rarely need to give you blood as a transfusion. What to expect after the operation Tiredness
In the 24-hour period after the anaesthetic you will probably feel tired. You may well feel fatigued for some days to weeks following the procedure (especially if you had lost a significant amount of blood). Pain
After the operation you will have some pain. Following keyhole surgery, this pain is often worse if you breathe or cough and, peculiarly, it may hurt on the top of your shoulder. This is because of some undissolved air from the operation irritating nerve endings in your abdomen and chest. You will be given pain relief. You should expect to be sore for some days but it should always be improving. Following open surgery, you will have pain for some weeks and it will be sore to walk. You will take some weeks to recover following open surgery. Wound
You will likely have a dressing on your wound(s). The staff looking after you will have advised you on how to care for your wound. Usually the skin is closed with stitches which are under the skin and dissolvable. Infection is uncommon but should the wound become sorer, hot, red or become oozy, then you should ring your doctor. How long will I be in hospital?
This will vary depending on the operation you need. It is normally just a day after keyhole surgery and two to four days following open surgery. Will I be able to fall pregnant again?
The chances of conceiving and having a successful pregnancy after an ectopic pregnancy are slightly lower than normal, but generally very good. This will depend on the reasons behind having an ectopic pregnancy as well as your own gynaecological history. This will be a topic that your gynaecologist will discuss with you with regard to your specific circumstances. What are the chances of having another ectopic pregnancy?
Your chance of having another ectopic pregnancy is increased a little. However it is reassuring to know that nine out of ten future pregnancies will not be ectopic next time. It is important that you confirm that any future pregnancy is developing inside the womb with an ultrasound scan and blood tests early in the pregnancy. If the pregnancy is not in the womb will I bleed?
Yes. Although the pregnancy is not in the womb, the hormones produced by the early pregnancy cause the lining of the womb to become thickened. Therefore after your ectopic pregnancy is treated, you should expect some heavy period-like bleeding for a week or so. While the bleeding continues, it is best to use sanitary pads instead of tampons, as this will reduce the risk of infection. Baths or showers can be taken as required. Going back to work?
If you have had an operation, you are unlikely to feel fit enough for work as soon as you leave hospital so make sure you rest. An absence from work of one to two weeks (following keyhole surgery) or four to six weeks (following open surgery) is usually enough. The decision about when to go back to work will be discussed with your gynaecologist who can also provide you with a medical certificate. How long should I wait before trying for another baby?
When the bleeding stops and you are no longer sore, it is usually safe to start having sexual intercourse again. You may need a few weeks for your body to recover and then it depends on how you and your partner feel. You may not feel like having intercourse for a while or your sex drive might decrease. Your feelings and those of your partner need to be respected on this be loving and understanding to each other. You may ovulate unpredictably after this pregnancy and hence the time of your next period may be less certain. You may try again when you feel ready however, it is sometimes better to wait a few months before trying again for a baby. Discuss this with your specialist either before you leave hospital or at your check up visit.
Mater Mothers Hospital Level 5, Raymond Terrace South Brisbane Qld 4101 Ph 07 3163 8437 Fax 07 3163 1830 Email: firstname.lastname@example.org
Following an ectopic pregnancy it is natural to feel low and depressed. Give yourself and your body time to recover. It may help to talk over things with your partner, friends and other members of the family or close friends.
We will have also provided you today with a brochure regarding support following a pregnancy loss which you may find helpful.
If you experience any problems after discharge, please contact your specialist or present to the Mater Private Emergency Care Centre for review.
Information in this brochure was sourced from the Early Pregnancy Assessment Unit, Level 7, Mater Mothers Hospitals. Please telephone 07 3163 5132 if you would like to speak to someone from the unit. Mater Private Emergency Care Centre
2010 Mater Misericordiae Ltd. ACN 096 708 922. Mater acknowledges consumer consultation in the development of this patient information. Mater Doc Num: HOSP-005-00803 Last modified 12/11/2015. Share this page
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