An ectopic pregnancy happens when a fertilised egg implants outside the uterus, most commonly in a fallopian tube. Warning signs include one-sided abdominal pain, vaginal bleeding, and shoulder tip pain. Treatment options include monitoring, methotrexate injection, or keyhole surgery. Around 65% of people achieve a healthy pregnancy within 18 months.
About 95% occur in a fallopian tube. More rarely, they can occur on an ovary, in the cervix, in a caesarean section scar, or in the abdominal cavity. All ectopic pregnancies require medical attention.
Symptoms usually appear between weeks 4 and 12. They include one-sided abdominal pain that may come and go or be constant, vaginal bleeding or spotting that is different from a normal period, shoulder tip pain caused by internal bleeding irritating the diaphragm, pain when using the toilet, and feeling faint or dizzy.
If you have a positive pregnancy test and experience one-sided pain, bleeding, or shoulder tip pain, contact your GP or nearest early pregnancy unit urgently. If you feel faint or have severe pain, call 999. A ruptured ectopic pregnancy is a medical emergency.
Diagnosis involves a transvaginal ultrasound scan and blood tests to measure hCG levels. In a normal pregnancy, hCG roughly doubles every 48 hours. In an ectopic, levels often rise more slowly or plateau.
Sometimes a "pregnancy of unknown location" is diagnosed if nothing can be seen on the scan. This does not necessarily mean ectopic. You will be asked to return for follow-up scans and blood tests.
Expectant management. If the ectopic is very early and hCG levels are low and falling, your team may monitor with regular blood tests to see if it resolves on its own.
Methotrexate injection. A medication that stops the pregnancy from growing. You will need follow-up blood tests over several weeks. You must avoid becoming pregnant for at least 3 months after methotrexate.
Surgery (laparoscopy). Keyhole surgery to remove the ectopic pregnancy. The surgeon will try to preserve the fallopian tube where possible, though sometimes it needs to be removed. In an emergency, surgery is performed immediately.
Even if a fallopian tube is removed, you can still conceive naturally through the remaining tube. Around 65% of people achieve a healthy pregnancy within 18 months. Your risk of another ectopic is slightly higher (around 10 to 15%), so future pregnancies will include an early scan at 6 to 7 weeks.
Ectopic pregnancy is a pregnancy loss, and the emotional impact is real. The Ectopic Pregnancy Trust provides specialist support and a helpline at ectopic.org.uk.
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