Ectopic pregnancy

An ectopic pregnancy grows outside the womb, usually in a fallopian tube (one of the tubes between the ovaries and the womb). It can’t be moved into the womb or carry on to birth. If a tube bursts (ruptures), bleeding inside the body can be life-threatening and needs emergency surgery.

Symptoms that need action now

Call 999 now (UK) or 911 (US), or your local emergency number, if you could be pregnant and you have sudden severe tummy pain, pain at the tip of your shoulder, marked weakness or fainting. ACOG lists shoulder pain among the warning signs that need emergency care.

If you could be pregnant and have pain low in your tummy on one side, or vaginal bleeding, get help today. Contact your GP or NHS 111 in the UK, your obstetric clinician in the US, or your local urgent pregnancy service. Do this even if you haven’t had a positive pregnancy test. Symptoms alone can’t show where a pregnancy is growing.

An ectopic pregnancy doesn’t always cause symptoms at first. When it does, bleeding may come with a brown, watery discharge, or with discomfort when you pee or poo. If you’re pregnant and bleeding heavily, or bleeding with severe pain, shoulder pain or feeling faint, get emergency care.

How the pregnancy is checked

Checks may include an examination, an ultrasound scan to look for the pregnancy, and blood tests for the pregnancy hormone hCG. You may need to come back for more scans and blood tests. Ask the team what to look out for between appointments and how to reach them if anything changes.

Known risk factors include a past ectopic pregnancy, past surgery on the fallopian tubes, pelvic infection and fertility treatment. But ectopic pregnancy also happens to people with none of these. Having no past problems is not a reason to put off getting checked.

The main approaches to care

Your clinician will talk through which options suit you, based on your symptoms and test results. NHS guidance includes expectant management. This means close monitoring to see if the pregnancy goes away on its own, with more treatment if needed. You need to be assessed first and have an agreed plan for medical follow-up.

Treatment with medicine usually means methotrexate, which stops the pregnancy growing. It’s only suitable in some situations, and you must be able to come back for follow-up blood tests. Your doctor can explain the treatment, how it interacts with other things and what precautions to take. Before you leave, ask about medicines, supplements, alcohol and plans for another pregnancy.

Surgery removes the pregnancy and may also remove the affected fallopian tube. Emergency surgery is needed if the tube has burst. If there’s time to think about it, ask what the operation involves and what it may mean for your future fertility.

In the US, ACOG’s patient information focuses on medicine and surgery. It advises follow-up after either one. The tube can still burst during methotrexate treatment until the treatment is complete. So new severe symptoms still need urgent care.

Recovery, grief and another pregnancy

An ectopic pregnancy can be traumatic, even if the pregnancy wasn’t planned. You may be recovering from treatment while also coping with a loss. In the UK, ask your GP or pregnancy team about counselling. Elsewhere, ask your doctor. A partner can ask for support too.

Many people can get pregnant again, even after a fallopian tube is removed. But the chance of another ectopic pregnancy is higher. If you want another pregnancy, ask when the right time is after the treatment you had. If you do get pregnant, tell your clinician soon so an early scan can check where the pregnancy is.

For urgent mental health support in England, call NHS 111 and choose the mental health option. Elsewhere, contact your local urgent mental health service. In the UK, you can call Samaritans on 116 123. In the US, call or text 988.

Call 999 now (UK) or 911 (US), or your local emergency number, if you can’t keep yourself safe or a life is in immediate danger.