Ectopic pregnancy lowers chance of conceiving again

A team from Aberdeen has found that women who had an initial ectopic pregnancy had a lower chance of conceiving again than women who miscarried their first pregnancy; as well as a higher risk of a subsequent ectopic pregnancy than women who had previously had a miscarriage, termination or live birth.

However, their study, published in PLoS Medicine, also showed that the rate of perinatal complications in a pregnancy following ectopic pregnancy was not significantly higher than in primigravidae or women with a previous miscarriage or termination.

The authors suggest: “The reduced chance of a pregnancy and increased risk of a second ectopic following ectopic pregnancy indicates the need for a fertility follow-up in women who are keen to conceive. This would include pre-conception care, advice to seek expert consultation should they wish to start a family, and consideration of an early pregnancy scan to confirm an intrauterine gestation.”

But they add: “Overall, the results from this study are broadly reassuring in establishing that obstetric outcomes following ectopic pregnancy are no worse than those in women in their first pregnancy.”

Meanwhile NICE has warned doctors this morning to be aware that women with ectopic pregnancy commonly present with atypical symptoms and signs. It says in its draft guideline Pain and bleeding in early pregnancy, published today for consultation, that standards across England and Wales are currently variable, and some women do not receive optimum care.

The guideline points out that many women who have an ectopic pregnancy have neither typical pain nor bleeding but may present with other symptoms and signs including: breast tenderness, gastrointestinal symptoms, dizziness, fainting or syncope, shoulder tip pain, urinary symptoms, passage of tissue, rectal pressure or defecation, cervical motion tenderness, rebound tenderness or peritoneal signs, pallor, abdominal distension, enlarged uterus, tachycardia (>100bpm) or hypotension (<100/60mmHg), shock or collapse and orthostatic hypotension.

NICE proposes that all health professionals who care for women of reproductive age should have access to pregnancy tests. It adds that all women with pain and/or bleeding in early pregnancy should have access to a dedicated early pregnancy assessment service, where scanning and decision making about management can be carried out.

It also recommends that doctors should offer women with pain and/or bleeding a transvaginal ultrasound to confirm the location and viability of the pregnancy – or if this is unacceptable, a transabdominal ultrasound. If non-viability is confirmed then NICE advises expectant management for 7-14 days as the first-line strategy, and women may need psychological support.

Professor Mark Baker, director of the centre for clinical practice at NICE, said: “Ectopic pregnancies can be potentially life-threatening for the mother if they aren’t diagnosed and managed effectively. Unfortunately at the moment, standards can vary across the country and some women may not be receiving optimum care, particularly those who have an ectopic pregnancy but do not exhibit obvious signs of pain or bleeding.”