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Extrauterine pregnancy: symptoms, signs and treatments
Extrauterine pregnancy is a complication that occurs infrequently during pregnancy. It is characterised by the growth of the foetus outside the uterine cavity. It usually never goes unnoticed. Its signs and symptoms can be noticed by the pregnant woman. The diagnosis is then confirmed by an interrogation, a clinical examination and additional tests (ultrasound or laparoscopy). The treatment to be put in place is urgent.
What is an extra-uterine pregnancy?
Extrauterine pregnancy (EGU) is also called ectopic pregnancy. It is a problematic pregnancy in relation to the place where the embryo develops. The embryo develops during a normal pregnancy in the mother's uterus.
However, there are times when the egg fertilized by the sperm does not implant in the uterus at the very beginning of the pregnancy. It then develops in the fallopian tubes or even in the ovaries, in the abdomen or cervix.
It is called an extrauterine pregnancy when the embryo implants and develops in these locations, outside the uterus.
How common are extrauterine pregnancies?
Extra-uterine pregnancies occur in about 1 to 2 out of every 100 pregnant women, which is why it is important and reassuring to be aware of the signs so that you do not potentially miss out on such a pregnancy.
Extrauterine pregnancies were less frequent before the 1970s. Their frequency increased in the 70s and 80s and has stabilised since then.
What are the symptoms and signs of an extrauterine pregnancy?
Most women realise for themselves that there is something wrong with an extrauterine pregnancy. They experience severe pain of the kind that occurs with colic. These pains usually occur on one side of the lower abdomen. These pains can be accompanied by :
- blackish or sepia-like genital bleeding.
A medical examination can detect other signs of extrauterine pregnancy. These signs are :
- pain caused by palpation of the belly;
- the absence of tachycardia;
- if a pelvic touch is made, the uterus appears smaller than the theoretical progress of the pregnancy. However, as pelvic touching contributes little to the diagnosis, it is increasingly neglected.
What is the most common week of pregnancy for an extra-uterine pregnancy?
Extrauterine pregnancy occurs from the very first days of pregnancy. However, it is not detected right away, as it usually takes several weeks for a woman to know that she is pregnant.
Extrauterine pregnancies are therefore most often diagnosed after a few weeks of pregnancy, during the first trimester of pregnancy.
Can you have an extrauterine pregnancy without bleeding?
Bleeding is frequent but not systematic. In fact, the diagnosis of an extrauterine pregnancy can sometimes be made quickly, before the bleeding occurs.
It is therefore possible to have an extrauterine pregnancy without bleeding. However, extrauterine pregnancy does not go unnoticed. Other signs can be seen.
How is an extrauterine pregnancy diagnosed?
The diagnosis is based on :
- an interview with the pregnant woman;
- a clinical examination;
- a blood test;
- an ultrasound and laparoscopy.
The ultrasound is usually performed using a probe positioned in the vagina. This allows a better view of the uterus than with a probe simply placed on the belly.
A laparoscopy is often necessary. A laparoscopy allows the diagnosis of an extrauterine pregnancy to be confirmed with certainty and to say where the foetus has implanted itself.
The blood test simply confirms that the woman is indeed pregnant. It also allows certain elements to be identified with a view to a surgical operation, which is often necessary.
What are the risk factors for an extrauterine pregnancy?
Several risk factors for an extrauterine pregnancy have been identified:
- the age of the mother: women over 30 years of age are more likely to become pregnant than those under 30 years of age;
- the mother's smoking habits;
- a history of chlamydial infection of the tubes (sexually transmitted infection);
- a history of caesarean section for a previous pregnancy;
- a history of extrauterine pregnancy;
- fallopian tube disease or surgery;
- exposure to Distilbene (a hormonal drug).
Tobacco and chlamydia infection are the 2 factors that can be acted upon to limit the risk of extrauterine pregnancy. This can be done by stopping smoking several weeks before you conceive and by always having protected or unprotected sex if both partners are tested and negative.
What are the treatments for ectopic pregnancy?
There are three treatments:
- simple medical supervision. No action is taken, and the pregnancy will terminate on its own under supervision ;
- the administration of medication by injection. These drugs interrupt the pregnancy;
- surgery, performed under laparoscopy or laparotomy.
The type of treatment administered is chosen according to several parameters:
- severity of symptoms;
- the level of certain hormones in the blood;
- gestational age of the foetus;
- general condition of the mother;
- ultrasound results.
The gynaecologist determines the most suitable treatment for each patient.
Is an extra-uterine pregnancy dangerous?
An extra-uterine pregnancy can be dangerous if it is not treated in time. This is because the developing foetus can cause the fallopian tubes to rupture or bleed. In very rare cases, these events can lead to the death of the mother.
However, extra-uterine pregnancies are nowadays well known and quickly detected and treated.
Can we keep the baby in case of an extra uterine pregnancy?
Unfortunately, extra-uterine pregnancies must be terminated as soon as the diagnosis is made. If an extra-uterine pregnancy continues, the prognosis for both mother and foetus is just as serious.
What are the consequences of an extrauterine pregnancy for other pregnancies?
There is no difficulty in getting pregnant again after an extra uterine pregnancy: it does not affect sterility. On the other hand, there is a greater risk of having an extra uterine pregnancy again. Medical monitoring is therefore reinforced when you have already had an EP.
In very rare cases, the removal of both fallopian tubes has had to be carried out in the case of several advanced extra-uterine pregnancies. In this case, the couple must resort to IVF to give birth to a child.
- Risk Factors for Ectopic Pregnancy: A Comprehensive Analysis Based on a Large Case-Control, Population-based Study in France 2003 https://academic.oup.com/aje/article/157/3/185/71089?login=true