What Is a Tubal Pregnancy?

A tubal pregnancy is an abnormal pregnancy that takes place in the fallopian tube instead of the uterus. Generally referred to as an ectopic or extrauterine pregnancy, a tubal pregnancy happens when a fertilized egg is not able to make its way to the uterus and is left to grow in the fallopian tube, where it won’t be able to survive.

Tubal pregnancies can damage nearby organs and cause life-threatening internal bleeding, requiring emergency treatment.

Symptoms

In the first several weeks of gestation, symptoms of a tubal pregnancy can be similar to the symptoms of a normal pregnancy, such as a missed period, fatigue, and nausea. Pregnancy tests taken at the beginning of a tubal pregnancy will usually show a positive result, even though the pregnancy won’t be able to grow into a healthy baby.

Some people may experience no symptoms at first, but as the fertilized egg continues to grow in the fallopian tube, there can be some serious and more noticeable signs, including:

• Vaginal bleeding not related to a menstrual period
• Pelvic or abdominal pain
• Shoulder pain
• Weakness or dizziness
• The urge to defecate

Keep in mind that specific symptoms will vary by person, and the pain can come and go.

Causes

It’s estimated that close to one in every 50 pregnancies in the United States is a tubal pregnancy, but people in almost half of these cases have no known risk factors. While there’s not always a clear cause for experiencing a tubal pregnancy, some risk factors could make it more likely. These include:

• A history of cigarette smoking
• A previous ectopic pregnancy
• Damage or surgery to the fallopian tubes (such as tubal ligation or getting your “tubes tied”)
• Previous pelvic infections or pelvic inflammatory disease (PID)
• Using an intrauterine device (IUD) for birth control
• Fertility treatments such as in-vitro fertilization (IVF)
• Age older than 35 years
• Endometriosis
• Certain sexually transmitted infections (STIs)

Diagnosis

Tubal pregnancies are most often diagnosed in the sixth through the ninth weeks of pregnancy. Your healthcare provider will be able to diagnose a tubal pregnancy after a medical exam and other testing, which may include:

• Pregnancy test
• Pelvic examination to test for pain, tenderness, or a mass in the abdomen
• Abdominal and/or transvaginal ultrasound to locate the pregnancy and to evaluate for internal bleeding
• Blood test to check levels of human chorionic gonadotropin (hCG), a hormone the body produces during pregnancy
• Complete blood count to evaluate for anemia or other signs of blood loss
• Blood type in case a transfusion is needed

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

Treatment

Tubal pregnancies need urgent treatment to remove the fertilized egg and avoid any life-threatening complications. Depending on your specific symptoms and overall health, your healthcare provider will recommend treating the tubal pregnancy with medication or surgery. Several weeks of follow-up are required with both types of treatment.

Medication

The less-invasive option for treating a tubal pregnancy is using an injectable medication called methotrexate. This drug stops the pregnancy from progressing and dissolves the existing cells.

This is typically used in less emergent cases to stop the pregnancy from growing any further without harming the fallopian tubes and surrounding organs. It comes with some common side effects such as abdominal pain, vaginal bleeding, and nausea, which your healthcare provider will discuss with you.

After being treated with methotrexate—which often takes place at an outpatient center—your healthcare provider will schedule several follow-up appointments to monitor your hCG levels and make sure further treatment isn’t necessary. They will also give you instructions on activities and medications to avoid at home after using methotrexate.

Surgery

Surgical procedures to treat a tubal pregnancy are done on an emergency basis if the pregnancy is further along, there’s a risk or evidence of fallopian tube rupture, or there is another medical reason not to take the medication route.

This is usually a laparoscopic surgery done with a tiny surgical device equipped with a camera that is inserted through small incisions in the abdomen. It’s usually performed in a hospital under general anesthesia. Your surgeon will remove the pregnancy while trying to avoid further damage to the fallopian tube, though it’s not always possible to preserve it.

Many patients experience pain, fatigue, and bleeding after the laparoscopy, and there’s also the possibility for infection to occur at the surgical site. Your healthcare provider will provide instructions for at-home healing and care for the weeks after the surgical procedure.

Coping

Experiencing pregnancy loss can be devastating and emotional at any stage. It’s important to give yourself time to grieve while leaning on friends and family for support. Keep in mind that help from support groups, grief counselors, and other mental health providers is available if needed.

Be sure to talk to your healthcare provider or other healthcare professional if you think you might be experiencing signs of depression or need assistance locating resources.

A Word From Verywell

While it’s true that experiencing a tubal pregnancy can put you at a higher risk of having another one in the future, it’s important to point out that many people can go on to have a normal, healthy pregnancy later, either naturally or through IVF.

As long as you keep your healthcare provider or other healthcare professional informed about any plans to conceive again, they’ll be able to help monitor your next pregnancy closely to make sure everything is developing normally.