Ectopic pregnancy

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What is an ectopicpregnancy? An ectopic pregnancy is one thatdevelops outside of the womb (theword “ectopic” means “out of place”).Between 1 and 2 in 100 pregnancies inthe UK are ectopic and for somewomen, this can be a life-threateningcondition.

Usually in pregnancy, a sperm and anegg meet in one of the two tubes (theFallopian tubes) that connect theovaries to the womb (uterus). Thefertilised egg then moves down thetube by being wafted by fine hairsinside the tubes until it reaches thewomb two or three days later. Oncethere, it implants, attaching itself to thewomb lining and that is where itusually continues to grow and develop.

In an ectopic pregnancy however, afertilised egg implants outside of thewomb, usually in one of the Fallopiantubes. This is called a tubal ectopicor tubal pregnancy.

A tubal pregnancy cannot lead to thebirth of a baby. The Fallopian tubecannot expand as the womb does tomake room for a developing embryoand it does not have a sufficient bloodsupply. There is currently no way oftransferring the early pregnancy safelyto the womb.

In rare cases (3 to 5% of ectopicpregnancies) the pregnancy implantssomewhere other than the tube. Anon-tubal ectopic pregnancy might be:

• an interstitial ectopic: the pregnancy implants in the top corner of the uterus near the Fallopian tube

• a cervical ectopic: the pregnancy implants in the cervix (the neck of the womb)

• a scar ectopic: the pregnancy implants in the scar from a previousCaesarean section

• a cornual ectopic: the pregnancy implants in a corner of the uterus which itself has not formed normally

• a heterotopic pregnancy: a twin pregnancy where one is in the correct place but one is ectopic

• an ovarian ectopic: the pregnancyimplants in an ovary

• an abdominal pregnancy: the pregnancy implants somewhere within the abdomen

These are all rare conditions withindividualised treatment.

This leaflet focuses mainlyon tubal ectopic pregnancy,though some informationmight still be relevant fornon-tubal ectopics.

Ectopic pregnancy can be a very distressing and frighteningexperience. This leaflet aims to explain what ectopicpregnancy is, to provide you with information and to answersome of the most common questions about both facts andfeelings. We hope this will help at what can be a verydifficult time.

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Why does it happen?We don’t always know why an ectopicpregnancy has occurred, but there aresome known causes and risk factors.

As we’ve said earlier, a fertilised eggnormally takes two or three days totravel down the Fallopian tube to thewomb. It implants there between sixand seven days after fertilisation.

With an ectopic pregnancy, however,the fertilised egg’s journey is sloweddown and it implants itself before itreaches the womb. There are severalthings that can make it more difficultfor the egg to pass through the tube,including damage to the tiny hairs thatwaft it towards the womb. The causesinclude:

• a previous ectopic pregnancy

• infection in the uterus, Fallopian tubes or ovaries, especially if they develop into pelvic inflammatory disease (PID). Chlamydia is one example.

• surgery on the Fallopian tubes, perhaps for a previous ectopic pregnancy or for sterilisation (or to reverse sterilisation)

• abdominal surgery, such as having your appendix out, a Caesarean section, or surgery for an ectopic pregnancy

• endometriosis, a condition which can damage the Fallopian tubes

• some fertility problems. Even an IVF pregnancy can be ectopic.

• some forms of contraception, such as the progesterone-only pill

• cigarette smoking: smokers tend to have an increased level of a protein in their Fallopian tubes that can slow the progress of the fertilised egg.

It is sometimes thought that having anIUCD (intra-uterine contraceptivedevice, or coil) increases the risk ofectopic pregnancy. That’s not really thecase. It’s more that the IUCD is goodat stopping a pregnancy implanting inthe uterus, but can’t prevent itimplanting in the tube or elsewhere.

There is also a higher risk of ectopicpregnancy amongst women over theage of 35.

Many women who have an ectopicpregnancy, however, have no knownrisk factors.

The scan showed that the baby was in the tubeinstead of the womb. I asked if it could be movedbut was told it was impossible.

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What happens when apregnancy is ectopic?Not every case of ectopic pregnancy isthe same. It can be that:

The pregnancy stopsdeveloping and is graduallyreabsorbed back into the body, as inan early miscarriage. If the ectopicpregnancy resolves (ends) naturally,then no further treatment is needed.

Your doctor may not be able to tellwhether this was an ectopic pregnancyor a very early miscarriage. If so, itmay be called a pregnancy of unknownlocation (PUL).

There is a tubal miscarriageThe pregnancy cannot continuegrowing in the tube and is miscarriednaturally. The Fallopian tube contracts(squeezes and releases) to push thepregnancy out from the tube into theabdomen. Your body can then graduallyabsorb the pregnancy tissue, but anultrasound scan may show blood orfluid in your pelvis. You may needfurther tests and perhaps treatment.

The pregnancy continues togrow, stretching the thin wall of thetube. If untreated, the tube mayrupture (burst or tear open) and thisneeds to be dealt with urgently.

Non-tubal ectopicpregnancies may continue to growfor longer as they may have moreroom to do so. They rarely resolvewithout treatment, which is usuallysurgical. They can also be more difficultto diagnose so more tests may beneeded.

ovary ovary

uterus (womb) (where the pregnancy should grow)

fallopian tubes

ectopic pregnancy (pregnancy growing in the wrong place)

What are the symptomsof an ectopic pregnancy?You may have had one or more of thesymptoms listed below, probablybetween the fifth and tenth week ofyour pregnancy – but sometimes thereare no obvious symptoms. This canmake ectopic pregnancy very difficultto diagnose, especially if you do notknow or even suspect that you arepregnant.

Symptoms can include:

• Irregular vaginal bleedingBleeding that is different from your normal period. It may be constant but light over a number of weeks or you may have a brown discharge or spotting. Occasionally some women think they may have had a light period and then they start bleeding again 10-14 days later and do not realise that they are pregnant.

• Pain low in your abdomen, perhaps just on one side. It might start suddenly or develop gradually and it can be constant and severe.

• Shoulder-tip painPain where your shoulder meets your arm. This happens if there is internal bleeding into your abdomen.

• Bowel or bladder problemsYou may have diarrhoea and perhaps vomiting; or pain when opening your bowels or passing urine.

• CollapseYou may feel lightheaded, dizzy and/or faint. You may also have a feeling that something is very wrong. You might look very pale, have a racing pulse and feel sick.

• No symptomsYou may have no symptoms at all.

If you are or couldpossibly be pregnant nowand you have:

• abdominal pain and/or

• shoulder-tip pain and/or

• feel dizzy or faint and/or

• diarrhoea, pain on passing urine or opening your bowels

– you should seek medical adviceimmediately, even if you areusing contraception and don’tthink you could become pregnant.

If you have any of the othersymptoms listed on this page andyour pregnancy test is positive,you should speak to your doctoror midwife within 24 hours.

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I had a feelingsomething wasn’tquite right withthe pregnancy andat six and a halfweeks I doubledup in excruciatingpain.

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How is an ectopicpregnancy diagnosed?Ectopic pregnancy can be very difficultto diagnose. The symptoms can bemistaken for gastro-enteritis, irritablebowel syndrome, miscarriage or evenappendicitis.

In hospital, unless you are extremelyunwell, the first steps are usually:

• A medical historyYou will be asked about yoursymptoms, pregnancy history and your previous medical history

• A pregnancy test (urine and/or blood)

• An ultrasound scanYou are most likely to have atransvaginal (internal) scan, as thisprovides the clearest picture in earlypregnancy. It will not damage yourpregnancy. The scan could show:

• A pregnancy that is developing normally in the womb. You probablywon’t need further treatment unless your symptoms continue or get worse.

• A pregnancy that seems to be failing or has died. You will probablybe offered an appointment for another scan or options for treatinga miscarriage

• An empty womb. This finding is called a pregnancy of unknown location (PUL) and you will need further tests.

• A pregnancy developing outside thewomb – an ectopic pregnancy. This often can’t be seen in the first weeks of pregnancy, but might be seen later.

• Blood testsThese are to measure levels of thepregnancy hormone ßhCG in yourblood. In early pregnancy, the levelsshould double roughly every 48 hours.After a miscarriage, they drop quitequickly. If they rise slowly, or stay aroundthe same level over this time, this canmean a pregnancy is failing or an ectopicpregnancy. Some units also measure thelevel of the hormone progesterone inthe blood.This can sometimes help toshow if the pregnancy is failing orgrowing without having to repeat thehCG after 48 hours.

Blood tests alone cannot tell wherethe pregnancy is developing, but theycan help doctors monitor patientswho might have a growing ectopicpregnancy.

• LaparoscopyThis investigation is done undergeneral anaesthetic. A tiny camera ispassed through a small cut in yourabdomen so that your Fallopian tubesand internal organs can be seendirectly. If it is clear that there is atubal pregnancy, it will usually beremoved at the same time.

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I did not have anyof the typicalsymptoms andonly minimal painbut had I notpushed for bloodtests, there is littledoubt that theectopic would haveruptured.

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How is a tubal ectopicpregnancy managed(treated)? If you are very unwell, the only safeoption may be an urgent operation toconfirm the diagnosis and to stopinternal bleeding.

In most cases, though, there may beseveral options, depending on yourcondition, the scan report and anyadditional blood tests, and you shouldhave time to discuss these with yourdoctor.We describe these treatmentsover the next few pages.

Conservative or expectantmanagement

This is sometimes described as“watchful waiting”. It means that youdon’t have any active treatment, butare checked regularly to make surethat the ectopic pregnancy is endingnaturally.

You might be offered this treatment if:

• you are well (you have a normal pulse and blood pressure and little or no pain)

• there is no sign on the ultrasound scan that the tube has ruptured

• your ßhCG levels are relatively low and

• during monitoring these levels continue to fall.

If you do have conservativemanagement, you will need repeatedvisits to hospital to have yourpregnancy hormone levels checked.Until your results are back to normal,there is still a risk that your tubemight rupture.

During this time it is important tothink of who you would contact in anemergency for support if you becameunwell. It is also important not to havesexual intercourse as this can increasethe risk of rupture, and to avoidalcohol as this it may complicate thesituation if you become unwell.

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I was given plentyof informationthroughout theprocess but I thinkthis was becauseas an ex-nurse, Iknew and was notafraid to ask.

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I was able to have methotrexateas the ectopic was caught quiteearly. The injection was fineand I had no side-effects, but Ineeded two lots of treatmentand repeated blood tests beforethe pregnancy was over.

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Medical management

Sometimes an ectopic pregnancy canbe treated with drugs that stop thedevelopment of the pregnancy andallow it to be re-absorbed by the body.This may be offered if:

• you are well (you have a normal pulse and blood pressure and little or no pain)

• there is no sign on the ultrasound scan that the tube has ruptured

• you have a small ectopic pregnancy with no heartbeat

• your ßhCG levels are relatively low

The drug that is most often used ismethotrexate and it is usually injectedinto a muscle. Methotrexate is a drugthat is used for many conditions tostop the growth of rapidly dividingcells. It can cause abnormalities in adeveloping baby so it can only be givenwhen the diagnosis of ectopicpregnancy is certain.

Medical management isn’t suitable foreveryone, and especially not if:

• your pregnancy hormone levels are very high

• you have other medical problems that mean you should not use methotrexate (for example, kidney failure)

The advantage of medical managementis that if it is successful (which it is in90% of cases), you avoid having anoperation and probably won’t need tostay in hospital. If it is unsuccessful, youmay still need to have an operation.

After the injection you will needregular blood tests to measure yourhormone levels and check that theyare falling.

The blood tests are usually done atthe start of treatment, days 4 and 7after treatment; then weekly after thatuntil they are normal. This can take 4to 6 weeks, depending on the level atthe beginning.

About 15% of women will need asecond injection and a smaller numbermay need surgery.

Until your hormone levels are back tonormal, it is important not to havesexual intercourse as this can increasethe risk of rupture, and to avoidalcohol as this it may complicate thesituation if you become unwell.

Some women have mild side-effectsfrom the treatment, such as mouthulcers, abdominal pain, nausea or skinrashes. You are also more at risk ofsunburn and a small amount of hairloss.

If you have medical treatment, you willbe advised to wait three monthsbefore trying for another pregnancy.This is because the drug can beharmful to an early pregnancy byreducing the amount of folic acid inyour system.

It is important to make sure the drugis out of your system before you getpregnant again.

Once your hormone levels are back tonormal, it is also advisable to restartyour folic acid if you plan to try again.

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I’m glad I avoided surgery but the treatment mademe very sick and I was absolutely exhausted forabout two weeks.

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Surgical management(under general anaesthetic).

This is the recommended treatment if:

• you are acutely unwell, with severe pain or internal bleeding

• there is a live ectopic pregnancy

• your hormone level is very high

• the diagnosis is uncertain

The advantage of surgical managementis that it is a relatively quick treatmentthat does not usually require repeatedhospital visits and blood tests. It mayalso be the treatment that you preferwhen you compare it with the otheroptions. However, it is not usuallyoffered if your hormone levels arevery low unless there are othermedical reasons to do so.

In most hospitals, the operation is doneby laparoscopy (key-hole surgery). Thisinvolves making two or three small cutsto the abdomen so that a camera candirectly show the ectopic pregnancyand allow access for the instruments tobe used to remove it.

Laparoscopic (key-hole) surgeryshortens the length of time you needto stay in hospital and you will recoverphysically more quickly than after opensurgery.

But this might not be possible,because, for example:

• you are too unwell or

• you have had previous abdominal surgery or

• you are very overweight or

• the doctor operating is more skilledand experienced at performing open rather than key-hole surgery.

In this case, you will have an operationwhich leaves a scar along the pubichair line (bikini line).

In either operation, the doctor lookscarefully at the Fallopian tubes andother pelvic organs. This might give anidea of what caused the ectopicpregnancy, though this isn’t alwaysclear. It might also help your doctoradvise you about a future pregnancy.

I was very unwell and in a lot of pain. I was rushedinto theatre where they found I had an ectopicpregnancy which had ruptured. I’m slowlyrecovering but it’s been incredibly difficult.

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If this is your first ectopic pregnancy,your doctor will advise removing theaffected tube completely, with thepregnancy tissue inside. This is called asalpingectomy.

If you have damaged tubes, however,or had a previous ectopic – andespecially if you have already had onetube removed – there might beanother option. It might be possible toremove the ectopic pregnancy fromthe remaining tube, and leave the tubebehind. This is called a salpingotomy.

The advantage of this second option isthat you will still have at least onetube left. The disadvantages are that:

• it increases the risk that not all thepregnancy tissue is removed, and

• you will need additional follow-up to check your hormone levels, and

• there is a higher risk of a future tubal pregnancy.

Sadly for some women a furtherectopic pregnancy will result in theloss of both Fallopian tubes. This canhave a huge emotional impact and theonly option for a future pregnancywould be through IVF (in vitrofertilisation).

For further information, advice andsupport on the availability of thistreatment it is best to see your GP.

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It was like a doubleloss. I lost my babyand I lost one of mytubes. It felt like theend of the world.

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How is a non-tubalectopic pregnancymanaged?The management of non-tubalpregnancies depends on where thepregnancy has implanted and whetheror not it is still alive. Each case needsto be considered separately, but mostare managed surgically.

You might find it helpful to readDiagnosis and Management of EctopicPregnancy (Greentop Guideline No 21),produced by the Royal College ofObstetricians and Gynaecologists(www.rcog.org.uk). It is written forclinicians but you might still find ithelpful as it includes information abouttubal and non-tubal ectopic pregnancy.You can find it athttps://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.14189 .

After the treatmentIf you have surgical management, anytissue removed will be examinedunder the microscope to confirm thatit was an ectopic pregnancy. Thattissue is usually then disposed of bythe hospital, in accordance with theirsensitive disposal policy. If you preferto take the remains of your pregnancyhome to bury or to make your ownarrangements, you can ask for them tobe returned to you.

How long does it take torecover? Recovering from an ectopic pregnancyis different for everyone. You mightalso find that you recover physicallyquite quickly, but that your feelingsabout what has happened stay withyou for longer.

Physical recovery: your body

When can I go back to workor my usual routine?

Once you are home from hospital,you’ll probably need to take thingseasy for at least a few days, whatevertreatment you have had. If possible, itis best to return to work only whenyou feel ready both physically andemotionally. Your GP will be able toprovide you with a certificate (a “fitnote”) for work.

After surgical management

After key-hole surgery, you shouldrecover physically after about twoweeks. If you have open surgery it islikely to be up to six weeks.

You should get a period about 4 to 6weeks after your treatment, but thiscan take longer, particularly if yourusual cycle is longer than 4 weeks.

After medical management

You will need to wait for the results ofyour blood test on day 7 aftertreatment. If the results show that thehormone level is falling and thepregnancy is resolving, you can start toreturn to your normal routine.

You may still have bleeding for sometime, and it is best to wear pads ratherthan tampons to reduce the risk ofinfection.

Your period will not start until at least4 weeks after your hormones havereached very low levels.

When is it OK to starthaving sex again?

This very much depends on how youare feeling after the ectopic pregnancyand what treatment you have had.

After surgery, it is safe to have sexualintercourse once any bleeding anddischarge have stopped. Afterconservative and medical managementit is advisable to wait until your levelsare returning to normal.

You may want to wait longer, though,especially if you are feeling very tiredand/or you are still sore or in pain. Youmight also be worried about thepossibility of getting pregnant again(see page 17).

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The surgery wasthe easy part and I recoveredquickly. It wasthe emotionalrecovery thatwas hardest.

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Emotional recovery: your feelings

Are my feelings normal?

Everyone is different, but many womensay that ectopic pregnancy is a veryupsetting and frightening experience,even if they weren’t planning to have ababy.

There is no right or wrong way to feeland you’ll probably find that you havelots of ups and downs in the days,weeks and months after your loss.

You may have felt – or you might stillfeel – one or more of the following:

Shock

Perhaps you didn’t know you werepregnant until your ectopic wasdiagnosed. You had to cope withfinding out you were pregnant andthat it couldn’t survive all at the sametime.

You might have been treated as anemergency, with everything happeningvery quickly. You might have been veryfrightened, especially if you knew yourlife was at risk. You may still bereplaying those feelings of shock andfear in your mind.

Perhaps you are shocked by thoughtsabout what might have happened –such as “What if I hadn’t beendiagnosed in time?”.This can be true for your partner too.

You may feel very anxious – aboutwhat happened or about all sorts ofthings. And you may have difficultysleeping. If this becomes a realproblem for you, then it is probably agood idea to talk to your GP.

I felt nothing at allat first. The realityof the situationtook several daysto hit me.

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Everything happened so quicklyI never had time to think aboutit until after my operation.Once I was discharged fromhospital I was left feeling veryalone with so many ‘what ifs’running through my head.

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Loss and grief

You may feel very sad for the loss ofyour baby, and for the hopes anddreams you had for her or him. Thosefeelings might be very strong and lastlonger than you expect.

It can be very difficult, especially ifother people don’t understand that.

You may find it helps to talk to otherpeople who have had an ectopicpregnancy (see page 19).

Feeling “in limbo”

If you have been treated withmethotrexate or are waiting for theectopic to resolve naturally, you mayfeel in a kind of “limbo” for severalweeks.

It can be very upsetting to have to goback to the hospital for repeatedblood tests until your hormone levelsare back to normal.

If you have been advised to wait somemonths before trying again, you mightfeel that it is even harder to recoverand to begin to move forward.

Guilt and blame

You might wonder whether you aresomehow to blame for what hashappened. This may be especially trueif you find that you have or had aninfection, such as chlamydia.

It is important to know that infectionslike chlamydia are easily transmittedand often have no symptoms, so canstay hidden for many years. They arealso easy to treat.

You may feel angry with some of thehealth professionals who treated you.Sadly, ectopic pregnancy can be verydifficult to diagnose with certainty butyou may still feel that you might havebeen spared some of what you wentthrough if you’d had better care.

You might want to talk this throughwith someone whom you feel you cantrust (see page 19).

I’m glad I kept thetube but in someways I feel thetreatment madethe process longer. I think I felt therewas always a tinyhope that thepregnancy was stillviable.

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“Everyone tells mehow lucky I am to bealive. But I’ve lostmy baby and I justfeel so empty.

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Your partner

The experience of ectopic pregnancycan put a real strain on a relationship.It might bring you and your partnercloser together but you might findthat he or she doesn’t seem tounderstand how you feel and doesn’treact in the way you want or expect.

You may feel differently about whathas happened. Your partner may focuson your health, especially if s/he sawyou in pain and distress and perhapsfelt powerless to help.

Partners sometimes think they needto be strong and supportive, ratherthan show any feelings of loss orsadness.

It may just be that you deal with thingsor express yourselves differently andthis can lead to misunderstandings,anger and hurt, especially at avulnerable time.

You or your partners may find ithelpful to read our leaflet Partners Too.

It may be that you do not have apartner, and feel very alone. You mightneed extra support at this time.

Anxiety about the future

You may worry about whether you’llbe able to get pregnant again. Or youmight be frightened that if you dobecome pregnant, you might haveanother ectopic pregnancy. You maywonder whether you should try again,or whether you even want to.

We provide some information aboutthis on the next page. It may also behelpful to discuss your questions andconcerns with your doctor.

If you had surgery for the ectopicpregnancy, your doctor should be ableto tell you about the condition of yourwomb, tube(s) and ovaries and howthis might affect your future fertility –particularly if there is any obviousdamage to the other tube.

If you had problems getting pregnantthis time, you may want to ask if youcan see a specialist before trying again.

Getting support

Many women who have had an ectopicpregnancy – and their partners too –find that it can help to talk tosomeone who understands what theyare going through. This may be a friendor relative, or perhaps a bereavementnurse, midwife or counsellor.

You may prefer to talk to someoneyou don’t know personally, perhaps byphone or by using an Internet supportforum. See page 19 for somesuggestions.

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Vicki was terriblyupset and having a lot of pain too. I wanted to rescueher or take awaythe pain, and Icouldn’t do a damnthing except watchher cry.

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Thinking about thefuture

What about futurepregnancies?

The chances of having a healthypregnancy are still good aftertreatment for an ectopic, even if yourtube is removed.

You will ovulate (release an egg) asbefore, probably once a month. Andeven if you have just one Fallopiantube, it’s possible to get pregnant evenwhen you ovulate on the opposite side.

Overall about two thirds (64%) ofwomen will get pregnant againnaturally, while some will need help todo so (e.g. fertility treatment) andothers will decide not to try again.

What are the chances thatI’ll have another ectopicpregnancy?

The overall chance of you havinganother ectopic is between 7% and10% – so at most, 1 in 10. This willdepend on the kind of treatment thatyou had and the health of yourremaining tube or tubes.

If you had surgical treatment but thetube was not removed (salpingotomy),the risk of another ectopic is slightlyhigher, at around 15%.

When one Fallopian tube is damaged(because of infection or scarring, forexample), there is a higher chance thannormal that the other tube may bedamaged too. This means that:

• the chance of getting pregnant is less than normal

• there is an increased risk of another ectopic pregnancy if you dobecome pregnant.

The chance of having another non-tubal ectopic pregnancy is verylow, but if it was a cornual pregnancyand this was managed surgically, theremay be other concerns in the nextpregnancy. It is important to discussthis with your doctor at your follow-up appointment.

When is it best to try foranother pregnancy?

This will depend on the type ofectopic pregnancy you have and thetreatment you receive.

If you have had surgical treatment,your doctor will probably advise youto wait until you have had at least oneperiod before trying again. Aftermedical treatment, you will be advisedto wait at least three months.

You might want to get pregnant againas soon as possible or you may findthe thought of another pregnancy veryfrightening. You and your partner arethe best judges of when – or whether– to try again.

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The next time I fell pregnant I was full of fear,but an early scanreassured me,showing the babysafely in thewomb.

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What about contraception?

If you don’t want to get pregnant, youmay want to talk to your doctor orfamily planning clinic about what kindof contraception is best for you andwhat to avoid. After an ectopicpregnancy an IUCD (coil) is notrecommended; and some types ofprogesterone-only contraception canincrease the chance of having anotherectopic.

Will I need special care in mynext pregnancy?

The most important thing in your nextpregnancy is to find out early if it isdeveloping in the right place. So onceyou have a positive pregnancy test, it isbest to consult your GP so that he orshe can arrange for an ultrasound scanat around six to seven weeks.

It is not usually helpful to have a scanbefore six weeks as it can be too earlyto confirm where the pregnancy isdeveloping. However, if you have painor bleeding, it is best to go to yourlocal Early Pregnancy Assessment Unitfor assessment even if it is before sixweeks.

If you see a GP or hospital doctorwho doesn’t know your history, it isimportant to tell them about yourectopic pregnancy so they understandthat an early scan is important. It ishelpful to tell them or the personscanning you which Fallopian tube wasaffected and/or removed.

It is also essential to talk to yourdoctor if you might be pregnant andhave any symptoms that might meananother ectopic: a late period, bleedingthat is different from usual or any ofthe other symptoms listed on page 5.

If you are pregnant and an early scanshows a developing pregnancy in thewomb, then you are unlikely to needany further special care or tests. You’llbe booked in for routine scans ataround 12 and 20 weeks.

Finally:The experience of ectopic pregnancycan be extremely distressing. You mayfeel very relieved to be alive and freeof pain, yet still feel deeply sad at theloss of your baby and anxious aboutthe future.

Whatever your feelings and anxieties,you don’t have to bear them alone. Wehope that reading this leaflet has beenof some help and that you can usesome of the resources opposite tohelp on your journey to recovery.

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Just talking topeople thatunderstand whatI’ve been throughand how I’m feelingmakes me feel likeI’m not alone.

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Information andsupport

The Miscarriage Association

has a telephone helpline, a volunteersupport service, an online supportforum, Facebook groups and a range ofhelpful leaflets on pregnancy loss.Helpline: 01924 200799www.miscarriageassociation.org.uk17 Wentworth Terrace, WakefieldWF1 3QW

Ectopic Pregnancy Trust

provides information and support onectopic pregnancy.Helpline: 020 7733 2653www.ectopic.org.uk

For advice on symptoms, it is best tocall your GP, out-of-hours service orthe NHS 111 helpline (0845 4647 inWales).

If you suspect an ectopic pregnancy,seek help immediately from your GP,your nearest Early Pregnancy Unit, orAccident & Emergency Department.

For a list of Early Pregnancy Units:

www.aepu.org.uk (Association of EarlyPregnancy Units)

Useful reading

NICE clinical guideline (CG154)Ectopic pregnancy and miscarriage:Diagnosis and initial management in earlypregnancy of ectopic pregnancy andmiscarriage.National Institute for Health and CareExcellence, December 2012.http://www.nice.org.uk/guidance/CG154

Books:Small Sparks of Life, by Lysanne Sizoo Gopher Publishers, 2001;ISBN 90-76953-26-0

Hidden Loss: Miscarriage and EctopicPregnancy, edited by V. Hey, C. Itzin,L. Saunders and M.A. SpeakmanWomen’s Press 1995, 1996;ISBN 0-7043-44572

Other leaflets from theMiscarriage Association:Looking after your mental health duringand after pregnancy lossPartners Too Pregnancy loss and infertilityWhen the trying stops

Thanks Our sincere thanks to Dr JayneShillito, Consultant Obstetrician andGynaecologist, Leeds TeachingHospitals NHS Trust, and to Ms JackieRoss, Consultant Gynaecologist, King’sCollege Hospital, London, for theirhelp in writing this leaflet; and toeveryone who shared their thoughtsand experiences with us.

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Need to talk to someone who understands?

Call our support line on 01924 200799. Monday to Friday, 9am-4pm

Or email info@miscarriageassociation.org.uk

© The Miscarriage Association 2019Registered Charity Number 1076829 (England & Wales) SC039790 (Scotland)A company limited by guarantee, number 3779123Registered in England and Wales

EP/04/19

The Miscarriage Association17 Wentworth TerraceWakefield WF1 3QWTelephone: 01924 200799e-mail: info@miscarriageassociation.org.ukwww.miscarriageassociation.org.uk