An ectopic pregnancy happens when a fertilised egg implants and starts to grow outside the womb, most often in a fallopian tube. It cannot develop into a baby, and as it grows it can damage the tube and cause serious internal bleeding. That makes it one of the few early pregnancy problems that can be a true emergency.
The good news is that most ectopic pregnancies are now picked up early with blood tests and ultrasound, before the tube ruptures. This guide covers the symptoms, who is at higher risk, how it is diagnosed, the treatment options and what it means for future pregnancies.
What Is an Ectopic Pregnancy?
In a normal pregnancy, the egg is fertilised in the fallopian tube and then travels down into the womb (uterus), where it implants in the lining. In an ectopic pregnancy, the fertilised egg implants somewhere else. More than 9 out of 10 ectopic pregnancies are in a fallopian tube. Rarely, they implant in the ovary, cervix, a caesarean scar or the abdomen.
A fallopian tube is narrow and is not built to stretch. As the pregnancy grows, the tube can split open (rupture), which causes heavy bleeding into the abdomen. The NHS estimates that around 1 in 90 pregnancies in the UK is ectopic, and the American College of Obstetricians and Gynecologists (ACOG) gives a similar figure of about 2 in 100.
One point causes a lot of heartache, so it is worth saying clearly: an ectopic pregnancy cannot be moved into the womb, and it cannot continue. Treatment is about protecting your health and, where possible, your fertility.
Symptoms of Ectopic Pregnancy
Symptoms usually appear between the 4th and 12th week of pregnancy. Some people have none at all and only find out at an early scan. Others notice:
- A missed period and a positive pregnancy test, sometimes with normal early pregnancy signs such as sore breasts.
- Tummy or pelvic pain, often low down on one side. It may come and go, or be constant.
- Vaginal bleeding or brown watery discharge that is different from your usual period. It is easy to mistake for spotting before a period.
- Pain at the tip of your shoulder, where the shoulder ends and the arm begins. This is caused by internal bleeding irritating a nerve under the diaphragm and is an important warning sign.
- Discomfort when peeing or pooing, or diarrhoea.
These symptoms also happen with miscarriage and other conditions. Our guides to lower abdominal pain and sudden stabbing pelvic pain cover other causes Pelvic pain with a positive test needs checking the same day.
Who Is at Higher Risk?
Anyone who can get pregnant can have an ectopic pregnancy, and many happen without any known risk factor. Things that damage or block the fallopian tubes raise the chance:
- A previous ectopic pregnancy, the strongest single risk factor.
- Pelvic inflammatory disease (PID), often caused by untreated chlamydia or gonorrhoea, which can scar the tubes.
- Previous surgery on the fallopian tubes, including sterilisation or reversal of sterilisation.
- Fertility treatment such as IVF.
- Getting pregnant with a coil (IUD or IUS) in place. Coils make pregnancy very unlikely overall, but if one does happen, it is more likely to be ectopic.
- Smoking, which affects how the tubes move the egg along.
- Endometriosis and being over 35.
How Is Ectopic Pregnancy Diagnosed?
If you have symptoms or risk factors, you will usually be seen in an early pregnancy unit or an emergency department. Doctors use three main tools:
- Transvaginal ultrasound. A small probe placed in the vagina gives a clear view of the womb and tubes. It can show whether the pregnancy is in the womb and sometimes shows a mass in the tube or blood in the pelvis.
- hCG blood tests. Human chorionic gonadotropin is the pregnancy hormone. In a healthy early pregnancy it usually rises quickly over 48 hours. A slow rise, a plateau or an unusual pattern can point to an ectopic pregnancy. Two tests two days apart are common.
- Examination. A doctor may gently examine your tummy and pelvis to check for tenderness.
Sometimes it is too early to see the pregnancy anywhere on a scan. This is called a pregnancy of unknown location. It does not mean you have an ectopic pregnancy, but you will be followed up with repeat blood tests and scans until it is clear.
Treatment Options
The right treatment depends on your symptoms, your hCG level, the size of the pregnancy on the scan and whether there are signs of bleeding. Your care team will talk you through the options.
| Treatment | Who it may suit | What it involves |
|---|---|---|
| Expectant management | No or mild symptoms, low and falling hCG | Regular blood tests to check the pregnancy is resolving on its own |
| Methotrexate | Stable, no heartbeat seen, lower hCG, small pregnancy | An injection that stops the pregnancy growing so the body absorbs it, with follow-up blood tests |
| Surgery | Severe pain, signs of rupture or bleeding, higher hCG, or a larger pregnancy | Keyhole (laparoscopic) surgery to remove the pregnancy, usually with the affected tube |
Expectant management
Some early ectopic pregnancies stop growing and dissolve without treatment. If you are well and your hCG is low and falling, you may be offered close monitoring instead. You will need repeat blood tests until hCG reaches a non-pregnant level, and you must be able to get back to hospital quickly if symptoms change.
Methotrexate
Methotrexate is a medicine that stops cells from dividing. It is given as an injection, usually into the buttock, and avoids surgery. Blood tests track hCG over the following weeks, and a second dose is sometimes needed. Side effects include short-lived tummy pain and nausea. Because methotrexate can harm a developing baby, you will be advised to avoid getting pregnant for at least 3 months afterwards and to avoid alcohol and some medicines during treatment.
Surgery
Most operations are done by keyhole surgery under general anaesthetic. The two main types are:
- Salpingectomy: the affected tube is removed along with the pregnancy. This is the most common option when the other tube looks healthy.
- Salpingostomy: a small cut is made in the tube to remove the pregnancy while keeping the tube. This may be offered if the other tube is damaged, but it carries a small chance that some pregnancy tissue is left behind, so follow-up blood tests are needed.
If a tube has ruptured and you are bleeding heavily, emergency surgery is needed and may be open rather than keyhole. Recovery from keyhole surgery usually takes a few weeks. If your blood group is rhesus negative, you may be offered an anti-D injection after surgery.
Emotional Recovery
An ectopic pregnancy is a pregnancy loss, even if it was very early or unplanned. Grief, shock, anxiety and guilt are all common, and partners can be affected too. Some people also feel frightened by how suddenly things became an emergency.
- Give yourself time. Feelings can come in waves for weeks or months.
- Talk to someone you trust, or ask your GP or early pregnancy unit about counselling and support groups.
- Seek help if low mood, panic or flashbacks are not easing. Symptoms of anxiety, depression and post-traumatic stress are recognised after pregnancy loss and can be treated.
Nothing you did, such as exercise, sex or lifting, caused the pregnancy to implant in the wrong place.
Pregnancy After an Ectopic Pregnancy
Most people who have had an ectopic pregnancy go on to have a healthy pregnancy later, including those who have only one working tube. The chance of another ectopic pregnancy is higher than average, but most later pregnancies are in the womb.
- Wait until you feel ready physically and emotionally. After methotrexate, wait at least 3 months.
- Contact your doctor or early pregnancy unit as soon as you get a positive test, so they can arrange an early scan, usually at around 6 weeks.
- If you have trouble conceiving, ask about a fertility referral. Options such as IVF bypass the tubes.
For more on reproductive health, visit our women’s health hub.
Related reading: Heavy Periods: Causes, Treatment and When to See a Doctor.
FAQ
Can an ectopic pregnancy be moved to the womb?
No. There is no procedure that can move an ectopic pregnancy into the womb, and it cannot survive outside it. Treatment aims to protect your health and fertility.
Will a home pregnancy test be positive with an ectopic pregnancy?
Usually, yes. An ectopic pregnancy still produces hCG, so a home test is often positive. Only a scan and blood tests can show where the pregnancy is.
How soon do ectopic pregnancy symptoms start?
Most appear between weeks 4 and 12, often around weeks 6 to 8. Some people notice nothing until a tube ruptures, which is why early pain or bleeding should be checked.
Can I still get pregnant with one fallopian tube?
Yes. The remaining tube can pick up eggs from either ovary, and many people conceive naturally with one healthy tube.
Is shoulder pain really a sign of ectopic pregnancy?
Pain in the tip of the shoulder can mean blood is irritating the diaphragm. If you could be pregnant and have this pain, especially with tummy pain or dizziness, get emergency help.
The Bottom Line
An ectopic pregnancy is a pregnancy growing outside the womb, usually in a fallopian tube. It cannot continue, and if it ruptures it can cause life-threatening bleeding. If you have a positive test with one-sided pain, unusual bleeding or shoulder tip pain, get checked quickly. Caught early, it can often be treated with monitoring or medicine, and most people go on to have healthy pregnancies afterwards.
This article is for general information and is not a substitute for advice from your doctor.
Sources
- NHS: Ectopic Pregnancy
- ACOG: Ectopic Pregnancy
- Cleveland Clinic: Ectopic Pregnancy
- Cleveland Clinic: Salpingectomy
Medical disclaimer: This article is for general information only and is not a substitute for advice, diagnosis or treatment from a qualified health professional. If your symptoms are severe, sudden or getting worse, contact a doctor or emergency services.
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