Ectopic Pregnancy

What is an ectopic pregnancy?
When an egg is fertilised it should move down the fallopian tube into the womb to develop. However, sometimes the egg becomes stuck in the tube and begins to grow there. This is when the pregnancy is called an ectopic pregnancy. On some occasions, although rare the egg can be stuck in other places such as the ovary or the neck of the womb. As the egg has not reached the womb it is unable to develop. When an egg becomes stuck in an area other than the womb it is very dangerous and medication and surgery is often needed.

What causes an ectopic pregnancy?
The most common cause for an ectopic pregnancy is when there is damage to the fallopian tube which may have been caused by a previous infection. Also, the risk of developing an ectopic pregnancy can be increased if you have suffered from an ectopic pregnancy previously or you have had abdominal surgery.

What are the symptoms of an ectopic pregnancy?
The warning signs of ectopic pregnancy can start at any time, from soon after a missed period to around 14 weeks of pregnancy.

Symptoms include:

  • Severe pain on one side, low down in the abdomen
  • Pain when you have a bowel movement
  • Vaginal bleeding or a brown watery discharge
  • Shoulder pain
  • Feeling dizzy or faint

How is an ectopic pregnancy diagnosed?
The symptoms of an ectopic pregnancy can be similar to several other conditions. However, if you do have the symptoms of an ectopic pregnancy, you may be offered a pregnancy test. If a patient has the symptoms of an ectopic pregnancy and the pregnancy test is positive then a referral to an early pregnancy assessment service may be done.

There are several tests which can be performed to detect an ectopic pregnancy:

• Blood Test: this test measures the blood levels for a hormone called human chorionic gonadotropin (hCG). This hormone is produced by the placental tissue. If the blood test shows the hCG levels are lower than normal it is an indication that either the pregnancy is ectopic or a miscarriage will occur.

• Vaginal ultrasound: An ectopic pregnancy is usually diagnosed by performing an internal ultrasound scan. By performing this scan the reproductive organs can be viewed and it will normally show the location of the pregnancy.

• Keyhole Surgery: If there is still some uncertainty as to whether the pregnancy is ectopic keyhole surgery can be performed. This procedure enables the womb and fallopian tube to be viewed using a small camera which is passed in a small opening in the abdomen.
How is an ectopic pregnancy treated?
Unfortunately, the pregnancy cannot be saved when it is ectopic. If the ectopic pregnancy is diagnosed before it has caused the fallopian tube to rupture then it can be treated in the following ways:

• Monitoring: if the patient only has mild symptoms there is a chance the pregnancy will resolve on its own, this basically means that the fertilised egg will die and be absorbed into the tissue nearby which means that treatment is not required. This method is used when the hormone level hCG is very low. If this option is used to treat the ectopic pregnancy regular blood tests are needed to monitor the hormone levels and sometimes it is necessary for an ultrasound to be performed. If the blood tests do not show a continued drop in the hormone levels further treatment will be required.

• Medication: called Methotrexate can be prescribed to stop the ectopic pregnancy from growing. This medication works by stopping the embryo cells from growing. However, this medication is only suitable if:

  • The ectopic pregnancy is not causing a lot of pain
  • The hCG levels are less than 1500 IU/litre
  • The ectopic pregnancy is no larger than 3.5cm in diameter with no viable heartbeat
  • There is no intrauterine pregnancy, which would be confirmed by an ultrasound scan.

Methotrexate cannot be prescribed if the patient has a condition which weakens the immune system such as diabetes. They have a blood disorder such as anaemia or they have liver disease or kidney disease.

If this medication is used then the patient has to be closely monitored and regular blood tests must be performed. If the hormone levels do not drop after having this medication then it may be necessary to perform surgery. Even when this medication is prescribed there is still a risk that the fallopian tube can split.

• Surgery can be performed to remove the egg. This is the most common method of treatment for this condition. Normally the surgery can be performed through a keyhole operation whereby a small incision is made in the abdomen which enables a small camera and surgical instruments to be inserted to perform the operation. It is usually necessary to remove the fallopian tube. However, if the fallopian tube is ruptured it is normally necessary to perform the surgery by making a larger incision across the abdomen to stop the bleeding which occurs.
How can clinical Negligence occur when you have an ectopic pregnancy?
There are several different ways in which negligence can occur when a women has suffered from an ectopic pregnancy:

1. Delay in diagnosis: when a patient is suffering from an ectopic pregnancy it is essential that this condition is diagnosed as soon as possible. If the medical professionals dismiss the symptoms or conclude that the symptoms the patient has are due to another condition, it results in the woman not receiving the appropriate treatment. The later an ectopic pregnancy is diagnosed the more likely complications are to arise such as the fallopian tube rupturing. When a fallopian tube ruptures this causes severe internal bleeding and it is likely that a blood transfusion will be required. In some rare cases the patient can die. Further, when the fallopian tube ruptures the surgery has to be performed in open surgery which leads to more extensive scar as opposed to keyhole surgery which could be performed which results in minimal scarring.

2. Incorrect Fallopian Tube removed: for some women they experience negligence when the surgeon performing the operation to remove the ectopic pregnancy removes the incorrect tube or both fallopian tubes are removed. Such action will impact on the woman’s fertility. Further, if the incorrect tube is removed, it is likely that further surgery will be required to remove the correct fallopian tube.

3. The treatment provided fails: in some circumstances negligence can occur when a woman has received treatment to remove the ectopic pregnancy, but this fails or is incomplete and there is a failure to appropriately monitor the woman after she has undergone treatment. When such failings occur it can lead to the pregnancy continuing to grow thereby this can cause complications for the patient.

This is a summary of the main ways in which negligence can occur when a woman suffers from an ectopic pregnancy, but it is not an exhaustive list. Further, when surgery is performed negligence can sometimes occur. For more information on clinical negligence during surgical procedures please click here.

If you are concerned that you have suffered from clinical negligence when receiving treatment for your ectopic pregnancy please contact us today for a free no obligation chat.