An ectopic pregnancy happens when a fertilized egg implants itself outside the normal uterine cavity. This can occur in the ovary, abdomen, cervix or fallopian tube, in more than 95% of the time it occurs in the tube.

Usually diseased or scarred fallopian tube due to pelvic inflammatory disease (PID) or endometriosis or previous surgery or ovarian cyst (adhesions).

The early symptoms of an ectopic pregnancy are the same as a normal pregnancy, such as missed period, breast tenderness and sometimes nausea.

Further symptoms at early stage could involve cramping and lower abdominal pain. In deteriorating condition that will involve feeling more intense pain, heavy bleeding, dizziness and may be fainting attack and collapse. Shoulder tip pain when ectopic ruptures or leaks blood into the abdominal cavity.

1. Medical - by using Methotrexate a cytotoxic medication to stop growth of fertilised egg.
2. Surgical - if the ectopic pregnancy is advanced surgery will likely be needed to remove the fallopian tube before it ruptures causing severe haemorrhage which is performed via laparoscopy.

If you think you could be pregnant it is important to find out and get early prenatal care. Pain and bleeding during pregnancy is NOT normal. If you have any unusual symptoms including pain, vaginal bleeding, light headedness, dizziness or nausea this is considered as an emergency and a Doctor should be consulted. A pelvic ultrasound is required to make sure the pregnancy is in the right place.

Sometimes the fertilized egg does not continue to grow and the pregnancy is lost. This is called a miscarriage. Sometimes a miscarriage happens before a woman knows she is pregnant, and there is usually nothing that she did to cause it. It is an upsetting experience affecting women emotionally and physically.

• Missed miscarriage - no pain or bleeding perhaps regression of pregnancy symptoms such as nausea, breast tenderness and is usually diagnosed by ultrasound scan.
• Threatened miscarriage - slight bleeding with or without pain but still chance for pregnancy to survive.
• Inevitable (incomplete) miscarriage - part of the pregnancy is lost and cannot survive.
• Complete miscarriage - when all is lost and uterine cavity is empty.

There can be different reasons that a pregnancy will end suddenly. Most of the time miscarriage happens because the fertilized egg or fetus is not growing or developing normally. If the fetus does not form and the pregnancy tissue does not grow, this is called a “blighted ovum”.

Occasionally unknown reasons, however, 70% of cases are due to chromosomal/genetic problems. The majority can be so early as in blighted ovum and in that case a placenta has started but no embryo with sac developing. Other causes include infection (viral or cytomegalovirus, rubella or herpes virus) or could be due to uterine problems such as polyps, fibroids, deformity of uterus(septum) or immunological factors as in natural killer cells. Rarely molar pregnancy which is gestational trophoblastic disease (GTD) or hydatidiform mole which is again related to chromosomal dysfunction.

Bleeding as spotting or more, lower abdominal pain and cramp like discomfort. Loss of blood clots or vaginal fluid in excess as a gush (not to be confused with urine or trapped bath water in the vagina). In these situations help and reassurance can be invaluable for peace of mind. At London Gynaecology and Maternity Care we offer on the spot diagnostic service.

At London Obstetrics & Gynaecology Clinic a full history and examination is undertaken to ascertain the diagnosis and type of miscarriage. Then a plan of monitoring and treatment is made depending on the type of miscarriage, the stage of pregnancy and cause of miscarriage. For very early or complete miscarriage nature will takes its course and nothing will need doing other then follow up by serial blood test for pregnancy hormone (βHCG) and repeat ultrasound scan. Others will require evacuation of the uterus by medical means (tablets) or most commonly surgical procedure by evacuation of retained products of conception (ERPC). This is a very short procedure performed under local or general sedation anaesthesia.

There will be some period like vaginal bleeding and also mild cramping. This happens as the uterus (womb) is shrinking back as before the pregnancy. A follow up visit is mandatory in 3-4 weeks to ensure that the uterus is completely empty, of course, you can be seen earlier should there be any concern or problems arise, in particular, if there is heavy bleeding with clots, feeling hot and sweating which indicates infection developing. At Londongmc we explain and give instructions about what is expected.

At London Obstetrics & Gynaecology Clinic we recommend chromosomal/gene analysis of lost pregnancy tissue. This will help identify the chromosome pattern if it is abnormal and help in monitoring future pregnancy.

At London Obstetrics & Gynaecology Clinic women are advised to wait for a natural period after miscarriage for one or two months before trying again, however, it can happen that a women can fall pregnant again before seeing her next period.

At London Obstetrics & Gynaecology Clinic we offer full support via medications given to help to relax the uterus, promote blood supply and tackle immunological issues. This is in addition to full monitoring of pregnancy progress and emotional support for pregnant women.