Researchers are set to trial a new drug, which could potentially help women experiencing ectopic pregnancy to avoid emergency surgery.
The £1.6 million trial, led by the University of Aberdeen, will investigate whether a drug called mifepristone is more effective that the current medical treatment option for treating ectopic pregnancy – where the embryo starts to grow in the wrong place, outside of the uterus.
Funded by a Medical Research Council and National Institute for Health and Care Research partnership, the trial will be led by Dr Andrea Woolner, senior clinical lecturer at University of Aberdeen.
So, what is an ectopic pregnancy, and what warning signs should everyone be aware of?
What is an ectopic pregnancy?
“An ectopic pregnancy is when a fertilised egg implants outside the uterus, most commonly in one of the fallopian tubes, although it can also occur in other places such as the cervix, ovaries or abdominal cavity,” says Ms Ora Jesner, a consultant gynaecologist and obstetrician at London Gynaecology
“As these areas are not designed to support a growing pregnancy, as the ectopic pregnancy grows, it can cause the area to burst and cause internal bleeding which can be dangerous.”
In the UK, around 1 in every 90 pregnancies is ectopic, according to the NHS. Unfortunately, it isn’t possible to save the pregnancy once it’s established as ectopic.
“One of the biggest misconceptions is that an ectopic pregnancy can be moved into the right place in the uterus or saved,” says Munira Oza, chief executive of The Ectopic Pregnancy Trust.
What causes it to happen?
Jesner says: “Ectopic pregnancies are often caused by factors that disrupt the normal passage of the fertilised egg down the fallopian tube.”
However, it can be difficult to pinpoint an exact reason for each case.
“While there are certain factors that may increase the risk, I’m afraid it is impossible to know the precise reason for an ectopic pregnancy,” adds Oza.
Who is most at risk?
Jesner says that if you have previously had an ectopic pregnancy, tubal surgery or pelvic surgery, pelvic inflammatory disease (PID) or sexually transmitted infections (STIs) like chlamydia, your risk of ectopic pregnancy may be increased. Other risk factors include endometriosis, smoking and fertility treatment such as IVF.
However, Jesner stresses: “These are all risk factors for ectopic pregnancy, but you can’t always prevent an ectopic pregnancy and many patients with ectopic pregnancies have no risk factors at all.”
What are the symptoms?
Symptoms usually tend to develop between the fourth and 12th week of pregnancy.
“Symptoms of ectopic pregnancy can vary but include pain in the lower abdomen or pelvis, vaginal bleeding that is different from a normal period and shoulder tip pain, which can indicate internal bleeding,” says Jesner. “Weakness, dizziness, or fainting can also be signs of a ruptured ectopic pregnancy and internal bleeding.
“Another symptom includes gastrointestinal symptoms like diarrhoea or pain on opening bowels.”
Symptoms can be very similar to those of other conditions such as miscarriage, UTIs or an upset stomach, so may be misdiagnosed, adds Oza. Women who are experiencing these symptoms in early pregnancy should seek urgent medical attention to ensure early diagnosis and treatment.
How serious is it?
“Ectopic pregnancy can be life-threatening if not treated, particularly if the fallopian tube ruptures, causing internal bleeding,” warns Jesner. “Long-term complications include damage to the fallopian tubes, which can affect future fertility and increase the risk of recurrent ectopic pregnancies.”
How is it treated?
Treatment options depend on the specific symptoms, the size of the ectopic pregnancy and test results.
“If the ectopic pregnancy is small and likely to resolve on its own, expectant management is used,” says Jesner. “This option requires close monitoring by an Early Pregnancy Unit.”
If spotted early, it can also be treated via an injection, using a drug called methotrexate.
“The drug stops the pregnancy developing any further and it is gradually reabsorbed by the body, leaving the Fallopian tube intact,” explains Oza. “Methotrexate is most effective in early ectopic pregnancy, usually when the pregnancy hormone ‘beta hCG’ level is below 5000 mIU/mL.”
However, if the ectopic pregnancy is advanced and there are signs of internal bleeding, surgery is strongly advised.
“In most circumstances, the type of operation is through a technique called laparoscopy (keyhole surgery),” explains Oza.
Can you do anything to prevent it?
“It’s not always possible to prevent an ectopic pregnancy,” says Jesner.
However, there are things that may help reduce the overall risk: “Using condoms and early diagnosis and treatment of STIs can help prevent pelvic inflammatory disease, which can lead to scarring in the fallopian tubes.
“Quitting smoking also helps, as smoking damages the fallopian tubes and increases the risk of ectopic pregnancy.”
