An ectopic pregnancy results when a fertilized egg implants outside the uterus. Unfortunately, there’s no way to transplant an ectopic pregnancy into your uterus, so ending the pregnancy is the only option. About 2 percent of pregnancies are ectopic.
Because ectopic pregnancy is potentially dangerous for you, it’s important to recognize the early signs and get treatment as soon as possible.
After conception, the fertilized egg travels down one of your fallopian tubes on its way to your uterus. If the tube is damaged or blocked and fails to propel the egg toward your womb, the egg may implant in the tube and continue to develop there. (Most ectopic pregnancies occur in a fallopian tube, so they’re often called “tubal” pregnancies.)
Though it happens much less often, an egg can also implant in an ovary, in the cervix, directly in the abdomen, or even in a c-section scar.
It’s also possible to have one embryo implant normally in your uterus and another implant in a tube or elsewhere. This condition, called a heterotopic pregnancy, is extremely rare. Experts estimate that it happens in about 1 out of 4,000 to 10,000 pregnancies.
An ectopic pregnancy that isn’t recognized and treated quickly could result in a ruptured fallopian tube, causing severe abdominal pain and bleeding. This can lead to permanent tube damage, tube loss, or even death if very heavy internal bleeding is not treated right away.
Although an ectopic pregnancy can happen to any woman, having certain risk factors makes it more likely. One common risk factor is previously having any condition or surgery that affected your fallopian tubes, such as:
- Surgery – Tubal ligation for sterilization, tubal ligation reversal, or surgery to correct a problem with your fallopian tubes can increase your ectopic pregnancy risk. (If you’ve had other pelvic or abdominal surgery, your risk may also be higher, though to a much lesser degree.)
- A previous ectopic pregnancy – In a review of studies, researchers found that in women who had one ectopic pregnancy, the chance of having another ranged from 5 to 25 percent, depending on how the previous ectopic pregnancy was treated.
- Pelvic inflammatory disease (PID) – This bacterial infection in the uterus, ovaries, or fallopian tubes often results from untreated sexually transmitted infections (STIs), such as gonorrhea or chlamydia. PID doesn’t always cause symptoms, so having had either of these STIs also increases your risk for an ectopic pregnancy, even if you don’t think you have PID.
- Endometriosis – In this condition, the tissue that normally lines your uterus grows elsewhere in your abdomen, such as your ovaries, intestines, or fallopian tubes. If the tissue grows on your fallopian tubes, it causes inflammation and scarring, increasing your risk of an ectopic pregnancy.
- Fertility issues – Infertility is often caused by damaged tubes. If you get pregnant as a result of fertility drugs or in vitro fertilization (IVF), there’s a slightly higher than average chance that the pregnancy will be ectopic.
- Being age 35 or older – If you’re 35 or older, you may have accumulated risk factors over time, such as pelvic infections or changes in how well your fallopian tubes work.
- Smoking – Some experts theorize that smoking cigarettes may impair normal functioning of the fallopian tubes.
- Having a mother who took the drug DES during pregnancy – This drug used to be prescribed to prevent miscarriage and various pregnancy complications. If your mother took it while she was pregnant with you, you may have health problems, including abnormalities of your fallopian tubes and uterus, which increase your risk of an ectopic pregnancy.
- Taking progestin – only hormonal contraceptives. Some studies suggest that this somewhat increases your chance of an ectopic pregnancy.
Signs and symptoms may vary from woman to woman, but the most common indicators are a missed period, abdominal pain, and vaginal bleeding. However, many women have no symptoms at all until the ectopic pregnancy ruptures.
You may miss a period and begin to have some of the same symptoms you’d have during a normal early pregnancy, like sore breasts, fatigue, and nausea. If you take a home pregnancy test, you may get a positive result. Your abdomen may be tender, and if you have vaginal bleeding, it may be sporadic and light.
If you do have symptoms, take them seriously. Call your provider immediately if you have:
- Abdominal or pelvic pain or tenderness – You may feel it only on one side, but the pain can be anywhere in your abdomen or pelvis. It may be mild and intermittent early on, but it can also be sudden, persistent, and severe. It may be dull or sharp, and you may also have nausea and vomiting. You may find that the pain gets worse when you’re active or when you move your bowels or cough. If the fallopian tube has ruptured, your abdomen may be distended and swollen.
- Vaginal spotting or bleeding (if you’ve had a positive pregnancy test result) – It may look like the start of a light period. The blood may be red or brown, like the color of dried blood, and it may be continuous or intermittent, heavy, or light.
- Shoulder pain – Pain in your shoulder, especially when you lie down, is a red flag for a ruptured ectopic pregnancy, and it’s critical to get medical attention immediately. The cause of the pain is internal bleeding, which irritates nerves that go to your shoulder area.
- Signs of shock – If your fallopian tube ruptures, the blood loss can cause you to go into shock. Signs include a weak and racing pulse, dizziness, fainting, and pale, clammy skin.
It’s also important to seek early care if you know you have a high risk for an ectopic pregnancy and think you’re pregnant.
If you’re having fertility treatments and get pregnant, your healthcare provider will monitor your pregnancy carefully, but alert her immediately to any symptoms of a possible ectopic pregnancy.
An ectopic pregnancy can be tricky to diagnose. Your provider may suspect an ectopic pregnancy if you have pain during an abdominal or pelvic exam at your first prenatal visit, or if your provider detects a mass.
If you have symptoms that suggest an ectopic pregnancy, your provider will calculate how far along you are (if you don’t already know), then give you a blood test and an ultrasound to try to confirm the diagnosis.
During the ultrasound, the sonographer will examine your tubes and uterus closely. If your blood test reveals that the pregnancy hormone hCG is at a certain level but the sonographer can’t find the embryo (or evidence of an embryo) in the uterus, you may have an ectopic pregnancy. However, it’s also possible that you have miscarried or that you have a uterine pregnancy that is still in the very early stages.
If she can see an embryo in the fallopian tube, you definitely have an ectopic pregnancy. But in many cases, the embryo dies soon after implanting and is too small for the sonographer to find. Instead, she may notice that your fallopian tube is swollen or see blood clots as well as tissue left from the embryo.
If you’re not in pain and there’s still some question about the diagnosis, you’ll have another ultrasound and blood test in two days. If your hCG level doesn’t increase as it’s supposed to, this may indicate an ectopic pregnancy, a pregnancy in the uterus that isn’t viable, or a miscarriage.
Your provider will continue to monitor your condition very closely with blood tests and ultrasounds until she can confirm the diagnosis or your symptoms get worse.
If it remains unclear whether you’ve miscarried or have an ectopic pregnancy, your provider may do a surgical procedure called dilation and curettage (D&C) to remove any tissue in your uterus. Or she may do laparoscopic surgery to examine your tubes. In this procedure, your provider inserts a thin tube with a tiny camera into your abdomen through a small incision.
Treatment depends on whether the diagnosis is conclusive, the size of the embryo, and whether you’re experiencing pain, internal bleeding, or other concerning symptoms.
If the pregnancy is clearly ectopic and the embryo is still relatively small, your provider may give you the drug methotrexate. This medication is injected into a muscle and reaches the embryo through your bloodstream. It ends the pregnancy by stopping the cells of the placenta from growing. (The tiny embryo is reabsorbed into your body over time.)
As the drug begins to work, you may have abdominal pain or cramps and possibly nausea, vomiting, and diarrhea.
Afterward, you’ll have a series of blood tests to check your hCG levels and make sure that the treatment worked. You’ll continue to have this test until your level of hCG reaches zero. (This usually takes a few weeks.)
If you have any signs of shock or tube rupture during this process (see the above section on symptoms). You’ll need surgery to treat an ectopic pregnancy if:
- You’re too far along to get methotrexate.
- You’re in severe pain.
- You’re bleeding internally.
- You’re breastfeeding.
- You have certain health conditions that mean you cannot take the medication.
However, if there’s extensive damage to your fallopian tube, or if you’re bleeding profusely, the tube may need to be removed. (If you’re bleeding heavily, you may also need a blood transfusion.) It takes about a week to recuperate after surgery.
As with drug treatment, you’ll have a series of blood tests after the surgery to monitor your hCG levels and make sure that the procedure was successful. Again, this testing will continue until the level reaches zero, which usually takes a few weeks.
In some cases, laparoscopy may not be an option. For example, if you have heavy bleeding, extensive scar tissue in the abdomen, or if the embryo is too large, you’ll need a laparotomy. (This procedure involves a larger incision in the abdomen to remove the embryo under general anesthesia.)
As with laparoscopic surgery, your tube may be preserved or may need to be removed, depending on your individual situation.
Afterward, you’ll need about six weeks to recuperate. You may feel bloated and have abdominal pain or discomfort as you heal.
Yes. The earlier you end an ectopic pregnancy, the less damage you’ll have in the affected tube and the greater chance of a future successful pregnancy. Even if you do lose one of your tubes, you can still get pregnant without fertility treatment as long as your other tube is normal.
However, if your first ectopic pregnancy was the result of tube damage from an infection, tubal ligation reversal, or DES exposure, there’s a greater chance that the other tube is damaged as well. This may reduce your chances of conceiving and increase your chances of another ectopic pregnancy.
If you’re unable to conceive naturally because of damaged tubes, you may be a good candidate for fertility treatments such as IVF.
You may feel devastated by your experience. You’ve not only just lost a pregnancy, but now it also may be more difficult for you to conceive again. You may also be recovering from major surgery, which can make you exhausted and numb, or experiencing hormonal ups and downs that leave you feeling depressed and vulnerable. You may be eager to try again, or you may be frightened and wary.
In any case, you need time to recuperate both emotionally and physically before trying to get pregnant again. When you’re ready, talk with your provider about the best time to try to conceive.
Your partner may also be feeling sad or helpless and may have trouble figuring out how to express those feelings while still being supportive. This experience may bring you closer together, or it may strain your relationship. Consider counseling if you think it will help you or your partner recover. Just ask your provider for a referral if you don’t have someone in mind.