What Is an Ectopic Pregnancy?

An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tube, but it can also implant on the ovary, abdominal cavity, or cervix. Ectopic pregnancies are dangerous conditions that can lead to permanent damage and death if left untreated. It is vital to know the symptoms and seek emergency care if an ectopic pregnancy is suspected.

Types

In a normal pregnancy, a fertilized egg travels through a fallopian tube to the uterus, where it implants into the lining. When the egg implants elsewhere, it is called an ectopic pregnancy.

The majority of ectopic pregnancies—90%—occur in the fallopian tube, but 10% take place on an ovary, the outer layer of the uterus, the spaces between the fallopian tube, the abdominal cavity, or within a cesarean section scar.

Ectopic Pregnancy

Symptoms

The first symptoms of ectopic pregnancy are usually similar to a regular pregnancy, such as:

• A missed period
• Fatigue
• Nausea

However, sometimes there are no symptoms right away.

Pregnancy tests taken at this time will show a positive result, but ectopic pregnancies cannot grow into a healthy baby. Some common early signs of ectopic pregnancy, usually between six and 10 weeks after fertilization, are:

• Vaginal bleeding, including light bleeding
• Pelvic pain, sometimes on one side
• Shoulder pain
• The urge to defecate

Pain from ectopic pregnancy can come and go, and might be dull or sharp. It may be only on one side and get worse over time. You might feel faint or be dizzy due to low blood pressure caused by blood loss.

Left untreated, an ectopic pregnancy can cause the fallopian tube to burst, leading to severe bleeding. This condition is life-threatening.

Causes

Often, the cause of an ectopic pregnancy is due to a fallopian tube being misshapen or inflamed. Other reasons are hormonal imbalances or the fertilized egg not developing properly.

Half of those diagnosed with ectopic pregnancies have no known risk factors. However, there are some known risk factors, including:

• Smoking
• A history of ectopic pregnancy
• Damage or surgery to the fallopian tubes
• Previous infections of the pelvis, or pelvic inflammatory disease
• Pregnancy while using an intrauterine device (IUD)
• Assisted reproductive technology conception
• Maternal age over 35
• In the case of cervical ectopic pregnancy, a history of dilation and curettage (D&C) in a previous pregnancy
• Endometriosis
• A congenital disability of the fallopian tube

Diagnosis

Your healthcare provider will generally diagnose an ectopic pregnancy after an exam and testing. Usually, an ectopic pregnancy is detected by eight weeks. Common tests include:

• Pregnancy test, such as a urine test strip
• Pelvic examination
• Transvaginal ultrasound to locate the fertilized egg
• A blood test to check for human chorionic gonadotropin (hCG) levels

More than one ultrasound or multiple blood tests to check for hCG levels may be required before an ectopic pregnancy is diagnosed.

Treatment

Once an ectopic pregnancy has been diagnosed, your healthcare provider will put a treatment plan in place. This condition is an emergency, so you will likely go to an emergency room with no appointment necessary. The treatment you receive depends on your health and the decisions of your healthcare provider.

Methotrexate

The drug methotrexate will stop the pregnancy from progressing. It is given through injection as a less invasive option than surgery. After the injection, follow-up appointments to monitor the level of hCG will be necessary.

Methotrexate is given as a single dose, double dose, or multiple-dose treatment, depending on the situation.

Surgery

Surgery is used when necessary, such as when the fallopian tube is at risk of or has already ruptured. The most common type of surgery for ectopic pregnancy is called a laparoscopy and is done with multiple small incisions instead of a large one.

A small camera with a light is inserted so the surgeon can see the area needing treatment. Depending on the condition of the fallopian tube, it may be removed entirely with the pregnancy or fertilized egg, or, if possible, the surgeon will remove only the pregnancy.

Emergency surgery for ectopic pregnancy is used for life-saving purposes. It can be done by laparoscopy, as described above, or through an abdominal incision.

Risk Factors

Ectopic pregnancy is life-threatening, but once it has been treated successfully, there are no imminent risks.

It is wise to speak to your healthcare provider about the potential risk factors that may have played a role, especially if you plan to become pregnant again. Most people who experience an ectopic pregnancy will have a normal pregnancy, but your healthcare provider may recommend waiting a few months. Waiting can give time for the fallopian tube to heal, and reduce the chances of another ectopic pregnancy. 

If you have had a fallopian tube removed due to ectopic pregnancy, you can still conceive and have a normal pregnancy.

Since there are two fallopian tubes, a fertilized egg can travel through the unaffected tube to the uterus. In vitro fertilization (IVF) is also an option if you have trouble getting pregnant after an ectopic pregnancy. 

Coping

Pregnancy loss can be a devastating experience even if you were not expecting the pregnancy. Reach out to family and friends for support, and speak to your healthcare provider if you are experiencing signs of depression.

A Word From Verywell

It might feel scary to attempt pregnancy again, but many people go on to have healthy pregnancies after an ectopic pregnancy. Your healthcare provider will be sure to monitor you closely when becoming pregnant after a previous ectopic pregnancy to check that everything is developing normally.