Ectopic Pregnancy and COVID-19

Is there an increased risk of early pregnancy loss in relation to coronavirus?

According to the Royal College of Obstetricians and Gynaecologists (RCOG):
“There are currently no data suggesting an increased risk of miscarriage or early pregnancy loss in relation to COVID-19. Case reports from early pregnancy studies with SARS and MERS do not demonstrate a convincing relationship between infection and increased risk of miscarriage or second trimester loss.”

I am experiencing symptoms of ectopic pregnancy and am worried. What should I do?

We are very sensitive of the fact that the coronavirus is creating intense challenges for the NHS and we understand that no one wants to overburden the health service at this difficult time. However, we ask anyone who is suffering symptoms of ectopic pregnancy to seek medical attention. If not diagnosed and treated quickly, ectopic pregnancy is a life-threatening condition and medical professionals will not think you are wasting their time for getting checked out so please do seek medical attention. Your health is important.

According to the RCOG:
“If you experience symptoms of pelvic pain and/or bleeding during early pregnancy, you should contact your healthcare professional straight away. These are symptoms linked to ectopic pregnancy and also miscarriage and your healthcare professional will arrange an appointment for you to check your symptoms and ensure you receive the right care.”

I am receiving methotrexate treatment for ectopic pregnancy. Do I need to shield?

Methotrexate is an immunosuppressant when used for a long time to treat auto-immune diseases and skin conditions. The methotrexate regimen used for ectopic pregnancy is different; it is given in a maximum of two one-off doses to women with healthy immune systems and normal white cell counts. White blood cells fight infections. Very rarely, methotrexate causes the white cell count to fall and if this happens it could potentially impact their immune systems. In our medical advisers’ experience, this side effect is very rare and should neither prevent methotrexate being used, nor prompt women to routinely shield after having methotrexate.

According to the RCOG:
“It is likely the detrimental effects of methotrexate in COVID-19 are minimal in well women. Methotrexate is a mildly immunosuppressive medication but there is not thought to be a significant risk at the dose used to treat ectopic pregnancy. It is unlikely to increase vulnerability to COVID-19 and does not require home shielding after administration.”

I have been diagnosed with an ectopic pregnancy and am being treated expectantly (wait and watch) or medically (methotrexate) with multiple hospital visits scheduled.

It is important that you attend your hospital appointments as directed by your healthcare team.

Do I need to shield following surgical treatment for ectopic pregnancy?

We are not aware of any specific advice regarding shielding following surgical treatment for ectopic pregnancy and women who have had surgical treatment should follow the usual rules on social distancing.

When can I try to conceive again?

Trying to conceive can be a challenging time particularly after loss and especially in the current difficult circumstances.

Usually women and couples are often advised by doctors to wait for at least two proper periods/three months before trying to conceive again to allow time for emotional and physical healing.

Women are advised to book an early scan when they are next pregnant with their Early Pregnancy Unit. This is to check that the embryo is in the right place and takes place at around 6 weeks’ gestation. However, in the current climate with coronavirus, the National Health Service is seeing a reduction in resources and capacity and there is the aim to minimise hospital attendance. In light of this, guidance by the RCOG states:

“Unfortunately, early pregnancy units will not be able to offer ultrasound scans to provide reassurance to women who have no symptoms. This will also be the case even if you have a previous history of miscarriage or ectopic pregnancy.”
This means that is a woman is pregnant again after an ectopic pregnancy, she may not be able to have an early scan in the current pandemic. 

There is no official guidance in the UK about trying for a baby at this time and whether to start trying to conceive is a personal choice. A key consideration is a woman’s personal medical history particularly concerning an ectopic pregnancy and getting the care that she would need with any future pregnancy. The Association of Early Pregnancy Units suggests that women consider waiting until the pandemic is over before trying to conceive. This is to minimise the burden on the health service and to ensure women have full access to early pregnancy and maternity care. Ultimately, it is a woman/couple’s decision

I have had a previous ectopic pregnancy and am now pregnant again. Can I have an early scan?

According to the RCOG:
“Unfortunately, early pregnancy units will not be able to offer ultrasound scans to provide reassurance to women who have no symptoms. This will also be the case even if you have a previous history of miscarriage or ectopic pregnancy.”

If a woman has symptoms of ectopic pregnancy, she should seek medical attention.

I had methotrexate treatment, my levels have returned to non-pregnant, and have been offered the COVID-19 vaccine. Do I need to delay taking the vaccine?

According to doctors, the doses of methotrexate used to treat ectopic pregnancy are low and unlikely to result in low white blood cell count (white blood cells defend against infections) and so unlikely to cause issues with the vaccine. If you have any concerns, you could ask your doctors to carry out a blood test for a full blood count and check before being vaccinated.
There are no studies/data about this and so it is impossible to give a definitive answer. However, the general view is that there is no reason to delay.

The pandemic is causing me stress and anxiety. What can I do to help my mental health?

The EPT is always here to listen and our support services are available. The World Health Organization (WHO) has produced a stress management guide for coping with adversity, Doing What Matters in Times of Stress: An Illustrated Guide, which has lots of helpful ideas.

Key points for women from the RCOG guidance for rationalising early pregnancy services:

It is important to know that if you experience any health issues during early pregnancy that require you to be seen by your healthcare professional, an appointment in an early pregnancy unit will be offered and you will receive the care you need.
• Whilst hospitals are trying to minimise people entering in order to reduce the spread of the COVID-19 virus and to limit the impact on services, they are organised in such a way that they are
able to provide all acute services.
• If you have symptoms that may be associated with miscarriage or ectopic pregnancy, it is very important that you contact your healthcare professional. You will be able to speak with an experienced member of your healthcare team on the phone before your appointment. They will be best placed to advise you as to whether a visit to the hospital is necessary and to ensure you receive the care that you need.

Useful resources

Royal College of Obstetricians and Gynaecologists guidance for rationalising early pregnancy services in the evolving coronavirus (Covid-19) pandemic Version 1.2, 15 May 2020

ISUOG Consensus Statement on rationalization of early pregnancy care and provision of ultrasonography in context of SARS-CoV-2 3 April 2020

Coronavirus (COVID-19) Infection and Pregnancy
Royal College of Obstetricians and Gynaecologists, Version 12, 14 October 2020

COVID: staying alert and safe
Cabinet Office: 11 May 2020, as regularly updated

Coronavirus (COVID-19)
NHS website

Guidance for surgeons working during the pandemic
Royal College of Surgeons of England: 26 March 2020, as regularly updated