An ectopic pregnancy occurs when the fertilised egg starts developing outside the uterus (womb). An ectopic pregnancy mostly occurs in the fallopian tube, but on rare occasions can occur in the ovary, the abdomen or the cervix.

Sometimes a “wait-and-see” approach can be adopted, if there are indications that the problem will sort itself out. The method of treatment, however, normally consists of surgery to terminate the pregnancy. Depending on the stage in pregnancy, the condition of the fallopian tubes and the prior medical history, the operation may take place via keyhole surgery (laparoscopy). Keyhole surgery is often performed successfully, without the tube containing the ectopic pregnancy, having to be removed, although this is not always possible. In rare cases after the first treatment, medicines (prostaglandins and/or methotrexate) are administered to halt the pregnancy.

Without treatment, ectopic pregnancy can be very dangerous. If the embryo has already grown past a certain point, the fallopian tube may rupture causing severe and life-threatening internal bleeding.

Reduced fertility in women is often caused by a disorder and/or blockage of the fallopian tubes. For such women, every therapy used to help achieve pregnancy (including earlier surgery), adhesions (scar tissue), or a previous ectopic pregnancy can increase the chances of (another) ectopic pregnancy. Smoking can also increase the chances of an ectopic pregnancy.

In vitro fertilisation (IVF) - In this procedure, fertilised eggs (embryos) are replaced into the womb (uterus). Although this process therefore bypasses the fallopian tubes, there is still a slightly greater chance of ectopic pregnancy than normal. This can be explained by the movement of the embryo from the womb to the fallopian tube, after it is replaced but prior to implantation. About one in 20 (5%) of IVF pregnancies are ectopic.

If sharp abdominal pains are experienced in the early weeks of pregnancy, it is important to consider the possibility of ectopic pregnancy. (If, through prior ultrasounds, it is already clear that the pregnancy is taking place in the womb, then the abdominal pains are more likely to be caused by something else.) The main symptoms are:

• Sharp abdominal cramps or pains in the sides (can start as a dull pain and become more acute).
• Pain in the neck and shoulders.
• Menstruation-like bleeding accompanied by pains (but pain is the clearest indication).

Blood tests can also indicate that a pregnancy is ectopic. If levels of hCG are not rising at a normal rate or are constantly high, an ultrasound is necessary in order to rule out or confirm an ectopic pregnancy.

If the fallopian tube ruptures, bleeding will occur before an ectopic pregnancy is diagnosed or treated, the symptoms could become worse and include:

• Severe, sharp pains and sudden pain in the abdomen.
• Feeling weak or actually fainting.
• Pain in the shoulder area.