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An ectopic pregnancy is one that starts to grow outside the womb, most often in a fallopian tube. It cannot continue to term, and if the tube bursts it can cause dangerous internal bleeding. The warning signs are low tummy pain on one side, vaginal bleeding and, in an emergency, sudden severe pain with dizziness or fainting.
Caught early, ectopic pregnancy can be treated safely, and most women can still have a baby later. This guide explains the signs, who is at risk and what treatment involves.
What Is an Ectopic Pregnancy?
Normally the fertilised egg travels down the fallopian tube and settles in the womb. In an ectopic pregnancy it implants somewhere else. About 90 percent are in a fallopian tube, according to Cleveland Clinic. The NHS puts the frequency at about 1 in 90 pregnancies in the UK and Cleveland Clinic at about 2 percent, so figures vary by source.
It is nobody's fault and cannot be moved to the womb. The pregnancy has to be treated so that it does not harm the mother.
Early Symptoms
Symptoms usually appear between about weeks 4 and 12, and they can look like an ordinary early pregnancy at first. Look out for:
- A missed period and a positive pregnancy test
- Pain low in the tummy or pelvis, often on one side
- Vaginal bleeding, or brown, watery discharge
- Pain at the tip of the shoulder
- Discomfort when passing urine or stools
- Dizziness or weakness
Some women have no symptoms and the problem is found on an early scan. These symptoms can also come from less serious problems, so do not panic, but do get checked. Our guide to bleeding in early pregnancy covers other causes.
Emergency Signs: When the Tube May Have Ruptured
A burst tube causes heavy internal bleeding and needs urgent surgery. Go to the nearest emergency department at once if you have:
- Sudden, sharp, intense pain in the lower tummy
- Severe dizziness, fainting or near-fainting
- Looking very pale
- Pain in the shoulder, or strong pressure in the back passage
- Nausea together with any of the above
When to be cautious: if you might be pregnant and have one-sided pain with dizziness or fainting, do not wait to confirm with a test or to see if it settles. Go to hospital immediately. Ruptures are uncommon and treatable when care is quick.
Who Is More at Risk?
Anything that slows or blocks the egg in the tube can raise the risk. The NHS, Cleveland Clinic and MedlinePlus list:
- A previous ectopic pregnancy (the NHS quotes about a 10 percent chance of it happening again)
- Pelvic inflammatory disease or past sexually transmitted infections
- Earlier surgery on the tubes, including tubal ligation or its reversal
- Endometriosis
- Fertility treatment such as IVF
- Becoming pregnant with a coil (IUD or IUS) in place
- Smoking, and age over 35
However, Cleveland Clinic notes that up to half of women with an ectopic pregnancy have none of these risk factors. Anyone who is pregnant can be affected. You can lower some risks by treating infections early, using condoms, and not smoking. See our article on STI prevention and screening for women.
How Doctors Diagnose It
- A pelvic examination and a urine pregnancy test.
- A blood test for the pregnancy hormone hCG. A low level, or one that rises slowly, can raise suspicion. The test is often repeated.
- A vaginal ultrasound to see where the pregnancy is.
Sometimes the doctor cannot see the pregnancy at first and asks you to return for repeat tests. Please keep these visits. Most ectopic pregnancies are found in the first trimester. If you are unsure of your dates, our pregnancy week calculator can help.
Treatment Options
The right treatment depends on your symptoms, the scan, hCG levels and whether the tube has burst. Your doctor may advise:
- Watchful waiting: close monitoring when the pregnancy may resolve on its own, with another treatment if it does not.
- Medicine: an injection that stops the pregnancy growing, used only if the tube has not ruptured. You will need follow-up blood tests.
- Keyhole surgery (laparoscopy): removes the pregnancy, sometimes with the affected tube, under general anaesthetic.
- Emergency surgery: if the tube has burst, along with fluids or blood transfusion if needed.
If you are Rh negative, you may be offered an anti-D injection; read about Rh-negative blood group in pregnancy.
After Treatment and Future Pregnancies
Losing a wanted pregnancy is hard, and you may need time to grieve; our guide to miscarriage and emotional recovery has useful ideas for coping. Most women can have a healthy pregnancy afterwards, and many can conceive with just one tube. Some treatment may lower the chance of conceiving naturally, and the risk of another ectopic pregnancy is higher.
The NHS suggests waiting at least two periods after treatment before trying again, or at least three months after the injection. Cleveland Clinic also mentions about three months, so guidelines vary; follow your own doctor's advice. In your next pregnancy, tell your doctor early so that you can be monitored.
Tip: if you have had an ectopic pregnancy, note it in your medical file and mention it at every first antenatal visit.
When to See a Doctor
Contact a doctor the same day if you have a positive pregnancy test or a missed period with bleeding, one-sided pelvic pain or shoulder-tip pain. Treat any fainting, severe pain or heavy bleeding as an emergency. If you have had fertility treatment or earlier tubal problems, tell your doctor early in pregnancy; our infertility and reproductive care page explains the support available.
Talk to a Doctor
Chaitanya Hospital in Kadapa provides 24/7 emergency care; see emergency for details. For non-urgent concerns, book an appointment or call +91 944 103 0587. This article is for general awareness and is not a substitute for a doctor's advice.
References
This article was written in our own words from the following public health sources.
Educational content
Please note. This article is for general awareness and is not a substitute for a doctor’s advice, diagnosis or treatment. If you are worried about your health, or in an emergency, call +91 944 103 0587 or visit the hospital.
