An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.
The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won''t develop into a baby and your health may be at risk if the pregnancy continues.
Unfortunately, it''s not possible to save the pregnancy. It usually has to be removed using medicine or an operation.
In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year.
Symptoms of an ectopic pregnancy
An ectopic pregnancy doesn''t always cause symptoms and may only be detected during a routine pregnancy scan.
If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy.
Symptoms can include a combination of
a missed period and other signs of pregnancy
tummy pain low down on one side
vaginal bleeding or a brown watery discharge
pain in the tip of your shoulder
discomfort when peeing or pooing
But these symptoms aren''t necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a stomach bug.
Read more about the symptoms of an ectopic pregnancy.
When to get medical advice
Contact your GP or call NHS 111 if you have a combination of any of the above symptoms and you might be pregnant – even if you haven''t had a positive pregnancy test.
An ectopic pregnancy can be serious, so it''s important to get advice right away.
Your GP will ask about your symptoms and you''ll usually need to do a pregnancy test to determine if you could have an ectopic pregnancy.
You may be referred to a specialist early pregnancy clinic for further assessment, where an ultrasound scan and blood tests may be carried out to confirm the diagnosis.
Read more about ectopic pregnancy tests.
When to get emergency help
Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you experience a combination of:
a sharp, sudden and intense pain in your tummy
feeling very dizzy or fainting
feeling sick
looking very pale
These symptoms could mean that your fallopian tube has split open (ruptured). This is very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible.
A rupture can be life threatening, but fortunately they''re uncommon and treatable, if dealt with quickly. Deaths from ruptures are extremely rare in the UK.
How an ectopic pregnancy is treated
There are 3 main treatments for an ectopic pregnancy
expectant management – you''re carefully monitored and 1 of the treatments below is used if the fertilised egg doesn''t dissolve by itself
medicine – an injection of a powerful medicine called methotrexate is used to stop the pregnancy growing
surgery – keyhole surgery (laparoscopy) is performed under general anaesthetic to remove the fertilised egg, usually along with the affected fallopian tube
You''ll be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have.
Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant. Talk to your doctor about this.
Read more about treating an ectopic pregnancy.
Help and support after an ectopic pregnancy
Losing a pregnancy can be devastating, and many women feel the same sense of grief as if they had lost a family member or partner.
It''s not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.
If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your GP about this.
Support groups for people who have been affected by loss of a pregnancy can also help.
These include
The Ectopic Pregnancy Trust
Ectopic Pregnancy Foundation
Miscarriage Association
Cruse Bereavement Care
Read more about dealing with loss and find bereavement support services in your area.
Trying for another baby
You may want to try for another baby when you and your partner feel physically and emotionally ready.
You''ll probably be advised to wait until you''ve had at least 2 periods after treatment before trying again to allow yourself to recover.
If you were treated with methotrexate, it''s usually recommended that you wait at least 3 months because the medicine could harm your baby if you become pregnant during this time.
Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they''ve had a fallopian tube removed. Occasionally, it may be necessary to use fertility treatment such as IVF.
The chances of having another ectopic pregnancy are higher if you''ve had one before, but the risk is still small.
If you do become pregnant again, it''s a good idea to let your GP know as soon as possible so early scans can be carried out to check everything is OK.
What can cause an ectopic pregnancy?
In many cases, it''s not clear why a woman has an ectopic pregnancy. Sometimes it happens when there''s a problem with the fallopian tubes, such as them being narrow or blocked.
The following are all associated with an increased risk of ectopic pregnancy
pelvic inflammatory disease (PID) – inflammation of the female reproductive system, usually caused by a sexually transmitted infection (STI)
previous ectopic pregnancy – the risk of having another ectopic pregnancy is around 10%
previous surgery on your fallopian tubes – such as an unsuccessful female sterilisation procedure
fertility treatment, such as IVF – taking medicine to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy
becoming pregnant while using an intrauterine device (IUD) or intrauterine system (IUS) for contraception – it''s rare to get pregnant while using these, but if you do you''re more likely to have an ectopic pregnancy
smoking
increasing age – the risk is highest for pregnant women aged over 35
You can''t always prevent an ectopic pregnancy, but you can reduce your risk by using a condom when not trying for a baby to protect yourself against STIs, and by stopping smoking if you smoke.
Symptoms of an ectopic pregnancy usually develop between the 4th and 12th weeks of pregnancy.
Some women don''t have any symptoms at first. They may not find out they have an ectopic pregnancy until an early scan shows the problem or they develop more serious symptoms later on.
Main symptoms
You may have an ectopic pregnancy if you miss a period, have a positive pregnancy test, and have other signs of pregnancy.
Contact your GP or call NHS 111 if you have a combination of any of these symptoms and you think you might be pregnant – even if you haven''t had a positive pregnancy test.
Vaginal bleeding
Vaginal bleeding tends to be a bit different to your regular period. It often starts and stops, and may be watery and dark brown in colour.
Some women mistake this bleeding for a regular period and don''t realise they''re pregnant.
Vaginal bleeding during pregnancy is relatively common and isn''t necessarily a sign of a serious problem, but you should seek medical advice if you experience it.
Tummy pain
You may experience tummy pain, typically low down on one side. It can develop suddenly or gradually, and may be persistent or come and go.
Tummy pain can have lots of causes, including stomach bugs and trapped wind, so it doesn''t necessarily mean you have an ectopic pregnancy.
But you should get medical advice if you have it and think you might be pregnant.
Shoulder tip pain
Shoulder tip pain is an unusual pain felt where your shoulder ends and your arm begins.
It''s not known exactly why it occurs, but it can be a sign of an ectopic pregnancy causing some internal bleeding, so you should get medical advice right away if you experience it.
Discomfort when going to the toilet
You may experience pain when going for a pee or poo. You may also have diarrhoea.
Some changes to your normal bladder and bowel patterns are normal during pregnancy, and these symptoms can be caused by urinary tract infections and stomach bugs.
But it''s still a good idea to seek medical advice if you experience these symptoms and think you might be pregnant.
Symptoms of a rupture
In a few cases, an ectopic pregnancy can grow large enough to split open the fallopian tube. This is known as a rupture.
Ruptures are very serious, and surgery to repair the fallopian tube needs to be carried out as soon as possible.
Signs of a rupture include a combination of
a sharp, sudden and intense pain in your tummy
feeling very dizzy or fainting
feeling sick
It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions.
Your GP may examine you and offer a pregnancy test.
If you have the symptoms of an ectopic pregnancy and a positive pregnancy test, you may be referred to an early pregnancy assessment service for further testing.
Some of the tests you may have are outlined below.
test
Vaginal ultrasound
An ectopic pregnancy is usually diagnosed by carrying out a transvaginal ultrasound scan.
This involves ing a small probe into your vagina. The probe is so small that it''s easy to and you won''t need a local anaesthetic.
The probe emits sound waves that bounce back to a close-up image of your reproductive system on a monitor.
This will often show whether a fertilised egg has become implanted in one of your fallopian tubes, although occasionally it may be very difficult to spot.
Blood tests
Blood tests to measure the pregnancy hormone human chorionic gonadotropin (hCG) may also be carried out twice, 48 hours apart, to see how the level changes over time.
This can be a useful way of identifying ectopic pregnancies that aren''t found during an ultrasound scan, as the level of hCG tends to be lower and rise more slowly over time than in a normal pregnancy.
The results of the test can also be useful in determining the best treatment for an ectopic pregnancy.
Read more about how an ectopic pregnancy is treated.
Keyhole surgery
If it''s still not clear whether you have an ectopic pregnancy or the location of the pregnancy is unknown, a laparoscopy may be carried out.
This is a type of keyhole surgery carried out under general anaesthetic (where you''re asleep) that involves making a small cut (incision) in your tummy and ing a viewing tube called a laparoscope.
Your doctor uses the laparoscope to examine the womb and fallopian tubes directly.
If an ectopic pregnancy is found during the procedure, small surgical instruments may be used to remove it to avoid the possible need for a second operation later on.
Unfortunately, the foetus (the developing embryo) cannot be saved in an ectopic pregnancy. Treatment is usually needed to remove the pregnancy before it grows too large.
The main treatment options are
expectant management – your condition is carefully monitored to see whether treatment is necessary
medicine – a medicine called methotrexate is used to stop the pregnancy growing
surgery – surgery is used to remove the pregnancy, usually along with the affected fallopian tube
These options each have advantages and disadvantages that your doctor will discuss with you.
They''ll recommend what they think is the most suitable option for you, depending on factors such as your symptoms, the size of the foetus, and the level of pregnancy hormone (human chorionic gonadotropin, or hCG) in your blood.
Expectant management
If you have no symptoms or mild symptoms and the pregnancy is very small or can''t be found, you may only need to be closely monitored, as the
