Ectopic pregnancy

Your health expert: Mr Olayemi Kuponiyi, consultant obstetrician and gynaecologist
Content editor review by Victoria Goldman, May 2022
Next review due April 2025

An ectopic pregnancy is when a fertilised egg implants outside the lining of your womb (uterus). Unfortunately, the fertilised egg can’t survive and it’s not possible to save the pregnancy.

An image showing the location of the womb and surrounding structures

What is an ectopic pregnancy?

In a healthy pregnancy, an egg released by your ovary is fertilised by sperm in one of your fallopian tubes. The fertilised egg travels to your womb where it implants in the lining and grows into a baby. But in around 1 in every 100 pregnancies, the fertilised egg implants in the wrong place. This is nearly always in one of your fallopian tubes. When the fertilised egg implants in a fallopian tube it can’t go on to grow into a baby.

If you have an ectopic pregnancy, it may end by itself or the egg may keep growing. If the egg keeps growing, it may eventually split open (rupture) the tube. This can cause life-threatening internal bleeding. So, if you have an ectopic pregnancy, you may need immediate treatment to prevent complications.

Symptoms of ectopic pregnancy

Ectopic pregnancy symptoms usually appear about six to eight weeks after your last period. They’re similar to the symptoms of a miscarriage so you and your doctor may not be able to tell the difference at first. In a miscarriage, vaginal bleeding is usually the main symptom, with some pain later on. In an ectopic pregnancy, the pain usually comes first – there may be some vaginal bleeding, but not always.

Symptoms of an ectopic pregnancy may include:

not having periods
pelvic or tummy pain that may be on one side only – the pain may develop gradually or come on suddenly
bleeding from your vagina, which may be different from your normal period – it may be lighter, heavier or darker, and may contain clots
pain in the tip of your shoulder – this is caused by bleeding into your tummy, which irritates nerves that run to your shoulder
feeling dizzy or fainting if the ectopic pregnancy splits open and you have serious internal bleeding
diarrhoea and being sick
needing to poo constantly and feeling uncomfortable when you’re pooing

Not everyone with an ectopic pregnancy gets these symptoms. You may have no symptoms at all or you may just have one or two symptoms. Sometimes, an ectopic pregnancy is suspected when you have an early scan, even though you feel well. Everyone is different.

If you’ve missed a period or could be pregnant and have any of the above symptoms, contact your doctor immediately.

Diagnosis of ectopic pregnancy

Your GP will ask about your symptoms and medical history. They’ll also examine you and offer you a pregnancy test. If your pregnancy test is negative, it’s unlikely that your symptoms are being caused by an ectopic pregnancy.

If your pregnancy test is positive or your symptoms strongly suggest you have an ectopic pregnancy, your GP may refer you to a hospital specialist. You may go to a clinic called an early pregnancy assessment unit (EPAU). If you have severe symptoms of an ectopic pregnancy, your GP will call an ambulance to get you straight to hospital as an emergency.

At the clinic or hospital, you’ll be offered some further tests.

A transvaginal ultrasound scan. Sound waves from a probe inside your vagina help your doctor see where the pregnancy is. You may also have a tummy ultrasound. It can sometimes be hard to spot an ectopic pregnancy with an ultrasound scan so you may need to have repeated scans.
A blood test. This measures a pregnancy hormone called human chorionic gonadotrophin (hCG). Your doctor may repeat this test after two days to see how much the level of hCG goes up. It goes up less in an ectopic pregnancy than in a pregnancy that’s growing inside the womb.
A laparoscopy (keyhole surgery). You may need this when it’s still unclear whether or not you have an ectopic pregnancy, especially if you’re unwell. Your surgeon uses a narrow, tube-like, telescopic camera (called a laparoscope) to look at your fallopian tubes, ovaries and tummy. They put the laparoscope into your tummy through a small cut. You usually have a general anaesthetic for a laparoscopy, so you’ll be asleep during the procedure.

Treatment of ectopic pregnancy

An ectopic pregnancy can’t develop normally. So all of the treatments lead to the end of the ectopic pregnancy.

Your ectopic pregnancy treatment will depend on:

how severe your symptoms are
how advanced your pregnancy is
whether or not your fallopian tube has split open

Your doctor should also discuss with you whether you plan to get pregnant again in the future. See our Help and support section for more information on getting pregnant after an ectopic pregnancy.

Here we describe the treatment options for an ectopic pregnancy in the fallopian tubes – the most common kind of ectopic pregnancy. If you have an ectopic pregnancy in another site, your doctor will talk to you about the possible treatment options.

Watchful waiting (expectant management)

You may not need any treatment for an ectopic pregnancy because sometimes the pregnancy ends by itself.

Before deciding that this is a safe option for you, your doctor will check that:

the mass in your fallopian tube is smaller than three-and-a-half centimetres
you have no pain and your doctor isn’t worried about anything else to do with your health
your blood test shows the level of hCG is low and falling
you’re happy to agree to the necessary monitoring by the hospital

Your doctor will ask you to have regular blood tests for hCG until it can’t be detected anymore. You don’t have to stay in hospital, but you should go back if you have any more symptoms.

Expectant management is successful for between 7 and 9 out of every 10 people who have it. If it doesn’t work for you, you can go on to have medical treatment or even surgery if necessary.

Medicines

Medical treatment for ectopic pregnancy involves having one or more injections of a medicine called methotrexate. This stops the embryo cells from growing – the pregnancy is gradually absorbed by your body. Methotrexate treatment is only suitable if your pregnancy is still in the early stages.

After your injection, you’ll need to return for further monitoring of your hCG levels. Depending on the results, you may need another dose of methotrexate. You’ll have blood tests until hCG is no longer found in your blood.

Treatment with methotrexate can cause some side-effects. It often causes tummy pain for two or three days after the injection. It may also cause sickness and diarrhoea.

It’s important not to get pregnant again for the first three to six months after having a methotrexate injection. If you get pregnant during this time, methotrexate may harm your developing baby.

Some people can’t be treated with methotrexate because of their general health. If you can’t have methotrexate or if the medicine doesn’t work, your doctor will suggest you have surgery.

Surgery

You may need surgery to take away your fallopian tube and the ectopic pregnancy if:

medicines haven’t worked or you’re unable to keep going back for follow-up tests after medical treatment
your pregnancy is larger than 3.5 centimetres (1.4 inches) across
you have severe pain
you’re very unwell because your fallopian tube has ruptured, and you have internal bleeding – this is a medical emergency

Usually, you’ll have keyhole surgery using a laparoscope. You’ll have surgery under general anaesthesia. The laparoscope is put into your body through a small cut or cuts in your tummy. But sometimes your surgeon will need to make a larger cut to see the affected area directly. This is called open surgery or a laparotomy.

A salpingectomy is surgery that takes away your whole affected fallopian tube. You’ll usually have a salpingectomy if:

you want further pregnancies, and your other tube is healthy
your other fallopian tube is damaged but you don’t plan to get pregnant again

A salpingostomy takes away the ectopic pregnancy but leaves your fallopian tube in place. This gives your tube a chance to work normally again in future. You may have a salpingostomy if:

your other fallopian tube is damaged, and you want another pregnancy in the future
you have other reasons for low fertility and want another pregnancy in the future

If you have a salpingostomy, you’ll need to have follow-up tests to check your hCG levels. You may need to have the fallopian tube removed in the future or have further treatment with methotrexate.

Causes of ectopic pregnancy

Doctors don’t always know why an ectopic pregnancy happens. But some things may make you more likely to have one. These include:

pelvic inflammatory disease– this can damage your fallopian tubes, making it harder for the egg to pass through them
having had a previous ectopic pregnancy
a history of infertility (whether or not this was treated)
having had a sterilisation operation – if the surgery doesn’t work and you get pregnant, it’s possible this may be an ectopic pregnancy
smoking
being over 35

All methods of contraception lower your chances of having an ectopic pregnancy. This is because you’re much less likely to get pregnant at all when you’re using them. But if you do get pregnant while using certain types of contraception, you may be more likely to have an ectopic pregnancy. These contraception methods include:

intrauterine device (IUD)
intrauterine system (IUS)
the progestogen-only pill (POP)

If you’re using one of these forms of contraception and you think you may be pregnant, see your GP as soon as possible. If you do have an ectopic pregnancy, it’s easier to treat if it‘s diagnosed early on – and your chances of complications will be lower too.

It isn’t possible to prevent an ectopic pregnancy, but you may be able to reduce your risk by:

giving up smoking
protecting yourself against sexually transmitted infections (STIs), which can damage your fallopian tubes

Help and support

Having an ectopic pregnancy can affect you emotionally as well as physically. Everyone is different, but you may feel sadness and a sense of loss after having an ectopic pregnancy. It may have been a worrying or frightening experience, especially if you needed emergency treatment. You may find it upsetting to go back to the hospital for repeated blood tests. You may also be worried about whether or not you’ll be able to get pregnant again in the future.

If you can, try to talk to someone about how you’re feeling. This may be a friend or relative or perhaps a bereavement counsellor. Ask your doctor for information about the support available to you.

You may also find it helpful to look for information, advice and support online. See our Other helpful websites section for some organisations that can help. These have telephone helplines and internet support forums where you can talk to others about your experiences to help you recover.

Getting pregnant again

Your periods may start again after four to six weeks. Ask your doctor when it’s safe to start having sex again. This may depend on which type of treatment you had, if any. If you had methotrexate injections, you should use reliable contraception for at least three months – see our section on Treatment of ectopic pregnancy.

If you’ve had an ectopic pregnancy, your chance of having a normal pregnancy afterwards is good. Around 2 out of 3 women who’ve had a tube removed are able to get pregnant normally afterwards. This is the same for those who’ve had medical treatment with methotrexate. Even if you had your fallopian tube removed to treat the ectopic pregnancy, your chance of conceiving may only be slightly reduced.

If you’ve had one ectopic pregnancy, you’re more likely to have another one. Up to 1 in 5 women will have a second ectopic pregnancy. So, if you get pregnant again, it’s important to see your GP as soon as you find out you’re pregnant. You’ll need to have an ultrasound scan six to seven weeks into your pregnancy to check the embryo is developing in your womb.

Ectopic pregnancies usually happen in the fallopian tubes and can’t develop normally. See our What is an ectopic pregnancy? section for more information.

Not everyone has symptoms of an ectopic pregnancy. But the symptoms may include a missed period, some pelvic or tummy pain and bleeding from your vagina. See our Symptoms of ectopic pregnancy for more information.

Symptoms of an ectopic pregnancy usually first appear around six to eight weeks after your last period. An ectopic pregnancy may be picked up in an early scan even if you feel well. See our Diagnosis of ectopic pregnancy section for more information.

Ectopic pregnancy can cause similar symptoms to a miscarriage. But in an ectopic pregnancy, the fertilised egg is growing outside the womb and can’t survive. See our Symptoms of ectopic pregnancy for more information.

An ectopic pregnancy happens in around 1 in every 100 pregnancies. It happens when the fertilised egg implants in the wrong place. This is nearly always in one of your fallopian tubes.

Ectopic pregnancy

What is an ectopic pregnancy?

Symptoms of ectopic pregnancy

Diagnosis of ectopic pregnancy

Treatment of ectopic pregnancy

Watchful waiting (expectant management)

Medicines

Surgery

Causes of ectopic pregnancy

Help and support

Getting pregnant again

More on this topic

Did our Ectopic pregnancy information help you?

Ectopic pregnancy

What is an ectopic pregnancy?

Symptoms of ectopic pregnancy

Diagnosis of ectopic pregnancy

Treatment of ectopic pregnancy

Watchful waiting (expectant management)

Medicines

Surgery

Causes of ectopic pregnancy

Help and support

Getting pregnant again

More on this topic

Miscarriage

Pelvic inflammatory disease

Did our Ectopic pregnancy information help you?