An ectopic pregnancy happens when a fertilized egg attaches and starts growing somewhere outside the uterus (womb), most often in a fallopian tube. The pregnancy cannot grow safely there or be moved into the uterus. It can damage nearby tissue and cause dangerous internal bleeding, so prompt medical assessment is important. Treatment may involve close monitoring, medicine, or surgery, depending on the findings.
An ectopic pregnancy begins when a fertilized egg implants outside the uterus instead of attaching to its inner lining. The fallopian tubes, which carry eggs toward the uterus, are the most common location. An ectopic pregnancy may initially cause few symptoms or resemble an ordinary early pregnancy. Recognizing concerning symptoms and receiving timely medical care are important because complications can develop as the pregnancy grows.
Where does an ectopic pregnancy develop?
During a typical pregnancy, a fertilized egg travels through a fallopian tube and implants in the uterus, where it can grow and develop. In an ectopic pregnancy, implantation happens elsewhere. Most ectopic pregnancies occur in a fallopian tube, but implantation can also occur in an ovary, the cervix, or the abdominal cavity.
According to the NHS, an ectopic pregnancy cannot develop into a baby that can be born safely. The tissue outside the uterus does not provide the conditions needed for a normal pregnancy. As it grows, it can damage nearby structures. In a fallopian tube, this may lead to a rupture and serious internal bleeding.
What are the symptoms of an ectopic pregnancy?
Some people have no noticeable symptoms initially and learn about the problem during an early pregnancy scan. When symptoms occur, they often develop during the first trimester. They can resemble symptoms of other pregnancy-related or pelvic conditions, so their cause cannot be determined from symptoms alone.
Possible symptoms include:
- A missed menstrual period or other signs of early pregnancy.
- Lower abdominal or pelvic pain, sometimes mainly on one side.
- Vaginal bleeding or spotting that differs from a usual menstrual period.
- Brown or watery vaginal discharge.
- Discomfort when urinating or having a bowel movement.
- Pain at the tip of the shoulder.
The NHS guidance on ectopic pregnancy symptoms explains that these symptoms can appear in different combinations. Vaginal bleeding or pelvic pain during a possible pregnancy should receive prompt medical attention, even if a home pregnancy test has not been positive.
When should you seek emergency medical care?
Sudden, intense abdominal or pelvic pain, shoulder-tip pain accompanied by other concerning symptoms, marked dizziness, fainting, unusual weakness, or collapse may indicate internal bleeding from a ruptured ectopic pregnancy. This can be life-threatening. Call your local emergency number or go to an emergency department immediately if these symptoms occur. Do not wait for a pregnancy test or a scheduled appointment.
What causes an ectopic pregnancy?
An ectopic pregnancy can occur when the fertilized egg does not reach the uterus as expected. Changes or damage affecting a fallopian tube may interfere with its movement, but the exact cause is not always clear. An ectopic pregnancy can also occur in someone with no known risk factors, so its occurrence does not necessarily mean that an identifiable problem was present.
Which factors can increase the risk?
The MedlinePlus Medical Encyclopedia identifies several factors associated with an increased chance of ectopic pregnancy. These include previous problems involving the fallopian tubes, certain infections, and a history of ectopic pregnancy. The presence of a risk factor does not mean an ectopic pregnancy will occur.
- A previous ectopic pregnancy: Having had one increases the chance of another.
- Fallopian tube or pelvic surgery: Previous surgery may leave scarring or changes that affect the tubes.
- Pelvic inflammatory disease: Certain infections, including some sexually transmitted infections, can cause inflammation and scarring in the reproductive tract.
- Endometriosis: This condition is associated with an increased risk.
- Fertility treatment: Some treatments, including assisted reproductive techniques, are associated with a higher risk.
- Pregnancy with an intrauterine device (IUD) in place: Pregnancy is uncommon with an IUD, but when it occurs, the possibility of an ectopic pregnancy needs prompt assessment.
- Smoking and increasing age: Both are recognized risk factors, with risk increasing among pregnant people older than 35.
There is no guaranteed way to prevent every ectopic pregnancy. Preventing and treating sexually transmitted infections and avoiding smoking may help reduce some associated risks. However, an ectopic pregnancy can happen even when someone has taken steps to protect their reproductive health.
How do doctors diagnose an ectopic pregnancy?
Diagnosis involves bringing together symptoms, pregnancy history, examination findings, blood tests, and imaging. A healthcare professional may ask about the timing of the last menstrual period, the pattern of pain or bleeding, previous pregnancies, and relevant medical history. A physical examination may help identify tenderness, but an examination alone cannot reliably establish where a pregnancy is located.
According to Mayo Clinic, two important tests are a blood test for human chorionic gonadotropin (hCG), a hormone produced during pregnancy, and a transvaginal ultrasound. The ultrasound uses a small probe inserted into the vagina to create images of the uterus and surrounding reproductive organs.
Why might more than one test be needed?
In a very early pregnancy, an ultrasound may not yet show clearly where implantation has occurred. If the location remains uncertain, healthcare professionals may repeat hCG blood tests and ultrasound examinations over time. They consider the results together rather than relying on a single hormone measurement or scan. This process helps distinguish an ectopic pregnancy from an early pregnancy inside the uterus that is not yet clearly visible.
How is an ectopic pregnancy treated?
An ectopic pregnancy cannot be relocated to the uterus and carried safely to birth. Treatment aims to end the ectopic pregnancy and prevent or manage complications, particularly internal bleeding. The approach depends on factors such as symptoms, ultrasound findings, hCG results, the person's overall condition, and whether a rupture has occurred.
The NHS treatment guidance describes three possible approaches: careful monitoring, medication, and surgery. These are not interchangeable options for every situation. A healthcare professional determines which approach is appropriate and explains the expected follow-up.
Careful monitoring
In selected cases, an ectopic pregnancy may resolve without medication or surgery. This approach, called expectant management, may be considered when the pregnancy is small, symptoms are absent or mild, and clinical findings indicate that close observation is appropriate. Repeated blood tests are needed to confirm that hCG levels are falling. Monitoring must continue as directed because the risk of rupture does not disappear immediately.
Medication
Methotrexate is a medicine that stops the pregnancy tissue from growing. It may be suitable when an ectopic pregnancy is diagnosed early and the person's condition and test results meet the criteria for treatment. Follow-up blood tests are essential to confirm that hCG levels fall as expected. Additional treatment may be needed if the medicine does not work as intended or complications develop. Pregnancy should be avoided for the period recommended by the treating clinician after methotrexate, commonly at least three months.
Surgery
Surgery may be recommended when medication or monitoring is unsuitable, or when the ectopic pregnancy has ruptured. Laparoscopic surgery, which uses small abdominal incisions and a camera, is commonly performed when the person's condition allows. The surgeon may remove the pregnancy while preserving the affected fallopian tube, or remove the tube if necessary. A rupture with internal bleeding requires emergency treatment to control blood loss and manage the pregnancy tissue.
Can you get pregnant again after an ectopic pregnancy?
Many people conceive successfully after an ectopic pregnancy, including some who have had a fallopian tube removed. Future fertility depends on several factors, including the health of the remaining fallopian tube, the circumstances of the ectopic pregnancy, and other reproductive health considerations. Having one ectopic pregnancy does increase the chance of another, but a future ectopic pregnancy is not inevitable.
The NHS guidance on recovery and future pregnancy recommends contacting a healthcare professional promptly when a new pregnancy occurs after an ectopic pregnancy. An early assessment and ultrasound may be arranged to check where the pregnancy is developing. After methotrexate, the recommended waiting period before trying to conceive is particularly important because the medicine can harm a developing pregnancy.
What is recovery like after an ectopic pregnancy?
Physical recovery depends on the treatment used and whether complications occurred. Follow-up appointments and blood tests may continue until pregnancy hormone levels have returned to the expected endpoint for the treatment. After surgery, recovery can take several weeks. Your healthcare team can explain when it is appropriate to resume usual activities and when to seek further care if pain, bleeding, dizziness, or other symptoms develop.
An ectopic pregnancy also involves the loss of a pregnancy, which can bring grief, anxiety, or uncertainty about future fertility. Emotional responses differ, and support from a partner, trusted person, counsellor, or pregnancy-loss support service may help. Seeking emotional support is appropriate even when the physical recovery is progressing well.