Ectopic pregnancy

An ectopic pregnancy happens when a fertilised egg implants in the wrong place. Almost always, this kind of pregnancy can't survive. There have been reports of an ectopic pregnancy surviving, but they are exceptionally rare.

About 1 in 80 pregnancies are ectopic. Like any pregnancy loss, an ectopic pregnancy can be deeply upsetting, and you may need some time to recover emotionally as well as physically.

After an egg is released by the ovary, it travels along a fallopian tube. There it can meet a sperm and become fertilised.

Once it's fertilised, the egg should keep moving along the tube and into the uterus (womb). Usually it then implants in the uterus and starts to develop.

In an ectopic pregnancy, the fertilised egg either doesn't reach the uterus or doesn't stop there. It implants somewhere it can't fully develop instead.

Most often, the fertilised egg implants in one of the fallopian tubes. Less commonly, it implants in the ovary, the cervix or the abdomen. It can also implant in a caesarean scar, or in other places within the womb wall.

An ectopic pregnancy can be life-threatening. Even though it's in the wrong place, the egg still tries to develop and get bigger. As it grows, the pregnancy can rupture (burst), causing damage and internal bleeding. If this happens, a person can lose a lot of blood into the abdomen (tummy) before any symptoms start.

The signs of an ectopic pregnancy differ from one person to another, and they depend on where the pregnancy is growing.

Symptoms are most often felt around the 6th to 7th week of pregnancy. But they can show up at any point between 4 and 12 weeks.

An ectopic pregnancy might cause:

• pain in your lower abdomen (tummy), which might come on quickly or gradually, and can be widespread or on one side only
• vaginal bleeding, which might be like your normal period, or lighter, heavier or darker than normal
• upset stomach
• sudden diarrhoea
• pain when you pee, that may feel like a urinary tract infection (UTI)
• pain when you poo, or in your back passage
• new pain in the tip of your shoulder

Call for emergency help or go to a hospital emergency department if you may be pregnant and:

• have new severe pain in your abdomen (tummy)
• have new severe pain in the tip of your shoulder that is worse when lying down, and painkillers don't help
• feel dizzy
• have fainted or collapsed

You may be pregnant and:

• have pain in your lower abdomen that can come on quickly or gradually, and can be widespread or on one side only
• have vaginal bleeding
• have an upset stomach and diarrhoea
• have pain when you have a bowel movement (poo)
• have a urinary tract infection
• have pain when you pee

Contact your doctor or a hospital that offers early pregnancy care.

If your case is an emergency, an ectopic pregnancy is diagnosed quickly and you'll get treatment straight away.

If your symptoms are only mild, it can take a little longer to reach a diagnosis. Your doctor, nurse or midwife will run tests to see whether your pregnancy is ectopic. These tests may include:

• a pregnancy test, if you've not already done one
• a physical examination of your abdomen (tummy)
• a transvaginal ultrasound scan, where a slim ultrasound probe is inserted into your vagina for an internal scan

Most ectopic pregnancies are found with a transvaginal ultrasound scan. But it's quite common for the first scan not to show where your pregnancy is. This is called a pregnancy of unknown location (PUL). It can mean that:

• your pregnancy is not in the right place, but hasn't been found
• your pregnancy is in the right place, but is too small to be seen on an ultrasound
• you've had an early miscarriage

You'll be offered blood tests to look for changes in your pregnancy hormones, and you may be asked to come back for more ultrasound scans. In these cases, you'll usually be diagnosed within 4 days. Less often, it can take a few weeks of follow up before you have a diagnosis.

The treatment you're offered for an ectopic pregnancy will depend on a few things, including:

• how many weeks pregnant you are
• your symptoms
• your test results

Your doctor, nurse or midwife will talk through your options with you, and what they might mean for your health and for your fertility (your ability to get pregnant) in the future. They'll work with you to plan your treatment.

If your fallopian tube ruptures, you'll be offered emergency surgery. The reason is that you're at high risk of severe bleeding, which could be life-threatening. There's no other way to treat a ruptured fallopian tube.

When an ectopic pregnancy is not an emergency, there are 3 different treatments. Depending on your circumstances, you may be offered:

• expectant management
• medical treatment
• surgical treatment

Expectant management means you wait and see whether the ectopic pregnancy ends by itself. Your doctor, nurse or midwife will check your hormone levels to decide if this is a safe option for you. They'll keep checking those levels as time goes on, to make sure waiting remains safe.

If the ectopic pregnancy does end by itself, you're likely to have some bleeding. During this time, use external period products such as pads rather than internal ones such as tampons. This lowers the risk of infection.

If expectant management doesn't work, you'll be offered other options.

In some cases, an ectopic pregnancy can be treated with medicine instead of surgery. You'll be given an injection of a drug called methotrexate, which stops the ectopic pregnancy from growing.

Most people need only 1 injection of methotrexate. However, 15% of people who have it will need a second injection.

There's a chance you'll still need surgery if the medicine doesn't work. This is more likely if your pregnancy is further along, or if your pregnancy hormone levels are high.

After the injection, you may have to go back to the clinic or ward for blood tests. These tests make sure the pregnancy has ended.

If you have any bleeding after the pregnancy has ended, use external period products (like pads) rather than internal ones (like tampons) during this time. This lowers the risk of infection.

If the treatment works, you won't need to have surgery.

An ectopic pregnancy that needs emergency treatment will always need surgery. Surgery is also an option for cases that aren't an emergency.

There are 2 types of surgery for ectopic pregnancy, and both remove the ectopic pregnancy.

Where possible, surgeons use keyhole surgery (also called a laparoscopy). They work inside your body with a tiny camera, so they only need to make a small cut in your abdomen (tummy).

In some cases, for example if there's internal bleeding, the surgeons may need to make a larger cut. This is called open surgery, or a laparotomy.

The type of operation you're offered will depend on:

• the urgency of your surgery
• the damage that your ectopic pregnancy may have caused
• your plans for a future pregnancy

Sometimes keyhole surgery has to change to open surgery. This can happen for a number of reasons.

If your ectopic pregnancy is in the fallopian tube, the tube is likely to be damaged. In that case your surgeon will need to remove it, and this can help lower the risk of another ectopic pregnancy in the future.

Having an ectopic pregnancy doesn't mean you can't have a successful pregnancy in the future. Even if one of your fallopian tubes has been removed, you still have a good chance of getting pregnant again. The tube that remains can "pick up" an egg from the ovary on the opposite side.

Doctors advise waiting for a while after an ectopic pregnancy before you try to conceive again. You should wait:

• 3 to 6 months after medical management, following the advice of your doctor or midwife
• until you've had 2 periods after surgical treatment

In both cases, wait until you feel emotionally ready to try again as well.

As soon as you know you're pregnant, contact your nearest maternity service and tell them you've had an ectopic pregnancy before. They may offer you extra scans to make sure the pregnancy is in the right place.

You may feel grief and loss after an ectopic pregnancy, and you may also feel anxious about getting pregnant again.

Read more about coping after you've lost a baby

Read more about getting pregnant again after ectopic pregnancy

If you feel you need more support after the loss, talk to your doctor. They can guide you on the support options open to you.