If a scan shows an empty uterus in the presence of a positive pregnancy test, that surely is an ectopic pregnancy?
Not necessarily. An "empty" uterus may be because there was a pregnancy there that has since been miscarried. Alternatively, there may be a pregnancy there that is still too small to be detected on the scan. Remember, a pregnancy five weeks or less will not be visible on the scan.
Does this mean a pregnancy that is in the tube cannot be seen on the scan (so as to remove any doubts)
Unfortunately, seeing an ectopic pregnancy on the scan is an exception rather than the rule. In most cases, the diagnosis is reached by exclusion and piecing the evidence together. It is not unusual to take a patient to theatre, only to find no ectopic.
Treatment for Ectopic Pregnancy
What happens after diagnosis of ectopic pregnancy?
The patient will be taken to theatre as an emergency. If the diagnosis is still in doubt, a diagnostic laparoscopy is performed. If the diagnosis is confirmed, the pregnancy is removed, either by opening the tube or by removing the entire affected tube with the pregnancy inside. The procedure is in many cases done entirely laparoscopically (by keyhole surgery) and the woman is able to leave hospital within twenty-four hours or so. Sometimes, this is technically not possible, which means opening the abdomen. This will mean a longer (3-5 day) hospital stay and a slightly longer recuperation period.
What are the consequences of an ectopic pregnancy?
Delay in presentation or diagnosis may lead to rupture of the fallopian tube, with potentially serious bleeding within the abdominal cavity. This will cause severe pain and occasionally fainting. The more enduring effect is that of reduced fertility. Following an ectopic pregnancy, chances of a normal pregnancy through natural conception are reduced to varying degrees. Moreover, there is an increased risk of a further ectopic pregnancy.
Can an ectopic pregnancy occur together with a normal intra-uterine pregnancy?
Yes. This used to be rare but is now much more common, with increase in assisted conception. Figures of one in 3000 are sometimes quoted. The ectopic pregnancy has to be removed to allow the normal pregnancy to continue. This state of affairs is known as heterotopic pregnancy.
Is surgery the only treatment available for ectopic pregnancy?
No. Chemotherapy is sometimes used as a form of treatment for ectopic pregnancy. It is not favoured by many, especially because of the potential side-effects, the inevitable delay, the intensive follow-up required to ensure cure, and occasional failure (around 7% of medically treated ectopics will fail, requiring surgery).
Methotrexate is the drug normally used if medical treatment of ectopic pregnancy is opted for. Where there is a high risk of rupture, medical treatment cannot be used. Also, where levels of the pregnancy hormone (beta-hCG) are very high, medical treatment is regarded as unsuitable because of high risk of failure and possible catastrophic tubal rupture.
Can an ectopic pregnancy grow to Term?
Yes, but not if it is in the tube. Continuing tubal pregnancies inevitably cause a rupture (of the tube) in the first seven to ten weeks. Cases of abdominal pregnancies (where there is plenty of room) which went unrecognised to the late third trimester have been reported, from time to time. When recognized, delivery (inevitably by operation) is carried out immediately. Because of the environment in which they grow (which is not ideal), these babies tend to have major limb deformities. A few have managed to be delivered in a surprisingly good physical state.
Can an ectopic pregnancy diagnosed while still intact be successfully transplanted into the womb?
Obstetricians are still unable to do this and it is not for lack of trying. Watch this space!
Last update: March 22, 2013