About ectopic pregnancy
In a usual, healthy pregnancy, an egg released by your ovary is fertilised by sperm in one of your fallopian tubes. It then travels to your womb where it implants in the lining and grows into a baby.
About one in every 100 pregnancies is ectopic, which means the fertilised egg implants outside your womb (uterus). Most often it implants in one of your fallopian tubes. Other places include:
- at the point where your fallopian tube meets your womb
- in one of your ovaries
- at the neck of your womb (cervix)
- in your abdomen (tummy)
- in a caesarean scar
Unfortunately, the fertilised egg can’t survive. The pregnancy may end by itself or it could continue to grow. You may need immediate treatment to prevent any complications. If the egg keeps growing, it can split open (rupture) the fallopian tube and cause life-threatening internal bleeding.
Symptoms of ectopic pregnancy
Symptoms of ectopic pregnancy usually appear about six to eight weeks after you last had a period. There are three common symptoms:
- not having periods
- pelvic or abdominal (tummy) pain – this is usually on one side although it can spread across both
- unusual bleeding from your vagina – the blood is often likened to prune juice and may or may not contain clots
However, not all women get these symptoms. Two in every 10 women with ectopic pregnancy don’t have bleeding and one in every 10 women doesn’t have pain.
Symptoms of an ectopic pregnancy are similar to those of a miscarriage and you and your doctor may not be able to tell the difference at first.
As they grow, ectopic pregnancies can bleed and eventually rupture. This may cause:
- pain in the tip of your shoulder – this is caused by bleeding into your abdomen, which irritates nerves that run to your shoulder
- feeling dizzy or faint – a ruptured fallopian tube can lead to serious internal bleeding, causing you to collapse
- diarrhoea and vomiting
If you’ve missed a period or could be pregnant and have any of the symptoms described, contact your doctor immediately.
Diagnosis of ectopic pregnancy
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.
Your GP will ask you to have a pregnancy test. You have a urine sample tested for a hormone called human chorionic gonadotrophin (hCG). This hormone is produced throughout pregnancy. If you have the symptoms of an ectopic pregnancy, a negative pregnancy test doesn’t rule out the possibility but does make it highly unlikely.
If your pregnancy test is positive, or your symptoms strongly suggest you have an ectopic pregnancy, your GP will refer you to a hospital specialist. This may be at a clinic called an early pregnancy assessment unit. 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 have some further tests. Your doctor may ask you to have a blood test to check your progesterone levels. It won’t tell them if your pregnancy is ectopic, but can help them work out if it’s viable – meaning that it’s showing signs of developing into a successful pregnancy – or not. To work out if your pregnancy is ectopic, you may have a blood test for hCG and an ultrasound scan. This uses sound waves to produce an image of the inside of your womb. You may have an abdominal ultrasound or a transvaginal ultrasound, where the sound probe is put inside your vagina.
If the scan shows your womb is empty but your blood test shows high levels of hCG, it's very likely you have an ectopic pregnancy. You may need to have another hCG blood test two days later to help your doctor decide how best to treat you.
If your doctor is still unsure, you may need to have a procedure called a laparoscopy. Your surgeon will use a narrow, tube-like, telescopic camera (called a laparoscope) to look at your fallopian tubes, ovaries and abdomen. They put the laparoscope into your abdomen 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 may either get smaller and end by itself, or get bigger and eventually split (rupture) your fallopian tube. This is a medical emergency. Your treatment will depend on how severe your symptoms are, how advanced your pregnancy is and whether or not your fallopian tube has ruptured.
Watchful waiting (expectant management)You might 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 centimetres and shrinking
- you have low levels of pain and there isn’t anything else causing your doctor concern
- you’re happy to agree to the necessary monitoring by the hospital
Your doctor will keep a close watch on your progress. They’ll ask you to have regular blood tests. You’ll have tests until hCG is no longer detectable.
Expectant management is successful for between seven and nine out of every 10 women who have it. If it doesn’t work for you, you can go on to have medical treatment or even surgery if necessary.
Medical treatment for ectopic pregnancy involves one or more injections into a muscle of a medicine called methotrexate. This stops the growth of the embryo cells and the pregnancy will gradually be absorbed by your body. This treatment is successful in nine out of every 10 women who have it.
To have this treatment, the mass in your fallopian tube must be smaller than four centimetres. After your injection, your doctor will continue to monitor your hCG levels. If they don’t fall far enough within a week, you’ll need to have another dose of methotrexate. Up to one in four women will need a second injection. You’ll have blood tests until hCG is no longer found in your blood. Your doctor may also ask you to have another ultrasound scan.
Treatment with methotrexate does have side-effects. Around three out of every four women treated will have some pain two or three days after their injection. It’s thought this is caused by the pregnancy separating from your body. The injections can also cause sickness or diarrhoea.
It’s important not to get pregnant again within three months of having a methotrexate injection or within six months if you need two injections. If you become pregnant, methotrexate may harm your developing baby, so you’ll need to wait for its effects to wear off.
Some women can’t have treatment with methotrexate. You may not be able to have it if you have:
- problems with your immune system
- liver disease
- lung disease
- kidney disease
- some types of blood disorder, including anaemia
If you can’t have methotrexate, or if treatment is unsuccessful, your doctor will suggest treatment with surgery.
SurgeryYou may need surgery to remove your fallopian tube and ectopic pregnancy if:
- medicines haven’t worked
- your pregnancy is larger than three-and-a-half centimetres across
- you have severe pain
Usually you’ll have keyhole surgery using a laparoscope for ectopic pregnancy. The laparoscope is a narrow, tube-like telescopic camera that is put into your body through a small cut.
If the fallopian tube that is unaffected by the ectopic pregnancy is healthy, your surgeon will most likely remove the affected tube and ectopic pregnancy. This is known as salpingectomy. If the fallopian tube unaffected by the ectopic pregnancy isn’t healthy, your surgeon may try to preserve the affected tube and remove the pregnancy through the laparoscope. They’ll do this by cutting open the affected tube (known as salpingotomy) or sucking (aspirating) it out. By doing this, your surgeon attempts to increase your chance of being able to have children in the future.
If you have a salpingotomy, you’ll need to have follow-up tests to check your hCG levels. There’s a chance you’ll need to have the fallopian tube removed in future, or have further treatment with methotrexate. See our medicines section above for more information.
If your fallopian tube ruptures, you may need to have emergency surgery to stop the internal bleeding. You may also need fluids and a blood transfusion if the internal bleeding is severe.
If you have an ectopic pregnancy, your surgeon may do a laparotomy. During a laparotomy your surgeon does the operation through one large cut in your abdomen. In general, your surgeon will try to do keyhole surgery as the procedure and recovery times are shorter. However, they may need to convert the procedure to a laparotomy.
Causes of ectopic pregnancy
The cause is unknown for more than half of women who have an ectopic pregnancy. But there are some factors that can make it more likely that you’ll have one.
An ectopic pregnancy can develop if your fallopian tubes are damaged. The most common cause of this is a past infection, such as pelvic inflammatory disease. If your fallopian tubes have been damaged, they may become inflamed, narrowed or scarred. This makes it harder for the fertilised egg to pass down them to your womb.
Other things that make an ectopic pregnancy more likely include:
- having a previous ectopic pregnancy
- a history of infertility (whether or not this was treated)
- getting pregnant when using certain types of contraception – see our FAQ: Contraception and ectopic pregnancy for further information
- smoking – may damage the tiny hair cells that normally help the fertilised egg move along the fallopian tube
- being over 35
- having had a sterilisation operation – if the surgery fails and you get pregnant, it’s possible this may be an ectopic pregnancy
It isn’t possible to prevent an ectopic pregnancy but you can reduce your risk. These include quitting smoking and taking measures to protect yourself against sexually transmitted infections (STIs), which can damage your fallopian tubes.
Help and support
It’s important to recognise that an ectopic pregnancy can affect you emotionally as well as physically. You may feel sadness and a sense of loss after having an ectopic pregnancy. If you can, try to talk to someone about these feelings. Ask your doctor for information about support that’s available to you.
FAQ: Can an ectopic pregnancy develop normally?
No, ectopic pregnancies aren’t able to develop properly. It isn’t possible for a pregnancy to survive if it implants outside your womb. Only your womb provides the right environment for a baby to grow and receive all the nutrition it needs.
Because an ectopic pregnancy can’t survive, the most important thing to consider when deciding on treatment is your health.
FAQ: Can certain types of contraception increase my risk of ectopic pregnancy?
It’s very unlikely that you’ll become pregnant if you’re using contraception correctly. But if you do, there’s a risk with some types of contraception that your pregnancy is more likely to be ectopic. This risk is associated with the intrauterine device (IUD), intrauterine system (IUS) and the progestogen-only pill (POP). Desogestrel – a type of POP – isn’t associated with an increased risk of ectopic pregnancy.
Of those women using the IUS and IUD who do become pregnant, four in every 100 have an ectopic pregnancy. Of those using the POP, 10 in every 100 pregnancies are ectopic. Overall, the risk of having an ectopic pregnancy isn’t actually increased by using these contraceptives. This is because the overall risk of becoming pregnant goes down.
If you think you might be pregnant, go and see your GP as soon as possible. If you do have an ectopic pregnancy, it is easier to treat and the risk of complications is lower if it is diagnosed early on.
FAQ: Can I get pregnant again after an ectopic pregnancy?
For most women who have had an ectopic pregnancy, the chance of having a normal pregnancy afterwards is good. Even if you had your fallopian tube removed to treat the ectopic pregnancy, your chance of conceiving may only be slightly reduced. Two out of three women who have had a tube removed are able to conceive normally.
However, you may be more likely to have another ectopic pregnancy. Between one in five and one in 10 women will have another ectopic pregnancy. The risk rises to one in three women after two or more ectopic pregnancies. This is because if you have had an ectopic pregnancy, one of your fallopian tubes is likely to have been damaged or even removed. However, this will depend on the type of treatment you had.
If you get pregnant again, it’s important to see your GP as soon as you find out. You’ll need to have an ultrasound scan six to seven weeks into your pregnancy to check the embryo is developing in your womb. An ultrasound uses sound waves to produce an image of the inside of your body.
FAQ: Can untreated ectopic pregnancy lead to cancer?
There’s no link between untreated ectopic pregnancy and cancer. The biggest risk of an untreated ectopic pregnancy that continues to grow is that your fallopian tube could rupture and cause life-threatening bleeding. If you think you may have an ectopic pregnancy, you should contact a doctor.
There’s a very rare type of cancer that can start from cells of any type of pregnancy, including ectopic pregnancy. It is called choriocarcinoma and is very treatable. Nearly all women are cured. This type of cancer only happens in about one in 50,000 pregnancies, so the chance of getting it after an ectopic pregnancy is extremely low.
- Ectopic pregnancy. BMJ Best Practice. bestpractice.bmj.com, last updated August 2015
- Conception and Prenatal Development. The MSD Manuals. www.msdmanuals.com, last reviewed October 2016
- Ectopic Pregnancy. Medscape. emedicine.medscape.com, last updated July 2016
- Ectopic Pregnancy. PatientPlus. patient.info/patientplus, last checked December 2015
- Ectopic Pregnancy. The MSD Manuals. www.msdmanuals.com, last reviewed January 2014
- Ectopic pregnancy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2013
- An ectopic pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published August 2010
- Fernandez H, Capmas P, Lucot JP, et al. Fertility after ectopic pregnancy: the DEMETER randomized trial. Hum Reprod 2013; 28(5):1247–53 doi.org/10.1093/humrep/det037
- Choriocarcinoma. Cancer Research UK. www.cancerresearchuk.org, last updated June 2016
- Bleeding in early pregnancy. Oxford handbook of general practice. 4th ed. (online). Oxford Medicine Online. oxfordmedicine.com, published March 2014
- Ectopic pregnancy and miscarriage. GP Update Handbook (online). GP Update Ltd, gpcpd.com, accessed April 2017
- Contraception – IUS/IUD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised August 2016
- Contraception – progestogen-only methods. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2016
- Elson CJ, Salim R, Potdar N, et al. On behalf of the Royal College of Obstetricians and Gynaecologists. Diagnosis and management of ectopic pregnancy. BJOG 2016; 123:e15–e55
We’d love to know what you think about what you’ve just been reading and looking at – we’ll use it to improve our information. If you’d like to give us some feedback, our short form below will take just a few minutes to complete. And if there's a question you want to ask that hasn't been answered here, please submit it to us. Although we can't respond to specific questions directly, we’ll aim to include the answer to it when we next review this topic.
Let us know what you think using our short feedback form
Reviewed by Laura Blanks, Specialist Health Editor, Bupa Health Content Team, April 2017
Expert reviewer Dr Raj Mathur, Consultant Gynaecologist
Next review due April 2020
About our health information
At Bupa we produce a wealth of free health information for you and your family. We believe that trustworthy information is essential in helping you make better decisions about your health and care. Here are just a few of the ways in which our core editorial principles have been recognised.
We are certified by the Information Standard. This quality mark identifies reliable, trustworthy producers and sources of health information.
What our readers say about us
But don't just take our word for it; here's some feedback from our readers.
“Simple and easy to use website - not alarming, just helpful.”
“It’s informative but not too detailed. I like that it’s factual and realistic about the conditions and the procedures involved. It’s also easy to navigate to areas that you specifically want without having to read all the information.”
“Good information, easy to find, trustworthy.”
Meet the team
Head of Health Content
- Dylan Merkett – Lead Editor
- Graham Pembrey - Lead Editor
- Laura Blanks – Specialist Editor, Quality
- Michelle Harrison – Specialist Editor, Insights
- Natalie Heaton – Specialist Editor, User Experience
- Fay Jeffery – Web Editor
- Marcella McEvoy – Specialist Editor, Content Portfolio
- Alice Rossiter – Specialist Editor (on Maternity Leave)
Our core principles
All our health content is produced in line with our core editorial principles – readable, reliable, relevant – which are represented by our diagram.
In a nutshell, our information is jargon-free, concise and accessible. We know our audience and we meet their health information needs, helping them to take the next step in their health and wellbeing journey.
We use the best quality and most up-to-date evidence to produce our information. Our process is transparent and validated by experts – both our users and medical specialists.
We know that our users want the right information at the right time, in the way that suits them. So we review our content at least every three years to keep it fresh. And we’re embracing new technology and social media so they can get it whenever and wherever they choose.
Here are just a few of the ways in which the quality of our information has been recognised.
The Information Standard certification scheme
You will see the Information Standard quality mark on our content. This is a certification programme, supported by NHS England, that was developed to ensure that public-facing health and care information is created to a set of best practice principles.
It uses only recognised evidence sources and presents the information in a clear and balanced way. The Information Standard quality mark is a quick and easy way for you to identify reliable and trustworthy producers and sources of information.
Certified by the Information Standard as a quality provider of health and social care information. Bupa shall hold responsibility for the accuracy of the information they publish and neither the Scheme Operator nor the Scheme Owner shall have any responsibility whatsoever for costs, losses or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of Bupa.
British Medical Association (BMA) patient information awards
We have received a number of BMA awards for different assets over the years. Most recently, in 2013, we received a 'commended' award for our online shared decision making hub.
If you have any feedback on our health information, we would love to hear from you. Please contact us via email: firstname.lastname@example.org. Or you can write to us:
Health Content Team
Battle Bridge House
300 Grays Inn Road