Medically reviewed by Fernando Mariz, MD — Written by Adam Felman on August 11, 2021
- Symptoms
- Complications
- Risk factors
- Diagnosis
- Treatment
- Prevention
- Summary
An ectopic pregnancy happens when the embryo settles anywhere other than the womb’s inner lining. This can lead to life-threatening complications.
Most ectopic pregnancies involve an embryo settling in a fallopian tube, but it can also happen in an ovary or the abdominal cavity.
An ectopic pregnancy can be fatal for the pregnant person without prompt intervention. The fallopian tube, for example, may burst, leading to shock and serious blood loss. Swift treatment is crucial. It cannot, however, preserve the embryo.
Around 1–2% of all pregnancies are ectopic. This issue is the cause of 3–4% of pregnancy-related deaths.
In this article, we describe the symptoms, complications, and risk factors for an ectopic pregnancy, as well as the treatment options.
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There may be no early indications that a pregnancy is ectopic.
Learn about the early signs of pregnancy here.
Symptoms of an ectopic pregnancy may develop as early as week 4 and as late as week 12 of the pregnancy, though they are more common in weeks 6–9.
The symptoms may include:
- Pain in the abdomen: This often occurs in the low pelvis area.
- Vaginal bleeding: The blood may be lighter or darker than the fluid of a menstrual period. It may also be less viscous.
- Shoulder pain: This can indicate internal bleeding. The bleeding may irritate the phrenic nerve, which causes the pain.
- Fainting or collapse: This a medical emergency can result from significant bleeding.
Without swift diagnosis and treatment, ectopic pregnancy can be life threatening for the pregnant person. Treatment cannot save the pregnancy.
Possible complications for the person include:
Internal bleeding: This can lead to shock and serious outcomes. The risk is higher when treatment is delayed.
Damage to fallopian tubes: This can lead to difficulty becoming pregnant in the future. The person’s other fallopian tube may function sufficiently for pregnancy.
After the removal of one damaged fallopian tube, pregnancy remains possible in the future. If both are removed, in-vitro fertilization remains an option for people hoping to become pregnant.
The following factors can lead to a higher risk of ectopic pregnancy:
- Previous ectopic pregnancy: Anyone who has had an ectopic pregnancy has a higher risk of another.
- Age: The older a person is, the higher the risk of an ectopic pregnancy.
- Infection: A history of inflammation and infection of the fallopian tubes, uterus, or ovaries can increase the risk of ectopic pregnancies.
- Sexually transmitted infections: Some sexually transmitted infections (STIs), such as gonorrhea or chlamydia, increase the risk of developing pelvic inflammatory disease (PID). Having PID can increase the risk of an ectopic pregnancy.
- Smoking: This may also increase the risk.
- Damaged or irregularly shaped fallopian tubes: Changes in the structure of a fallopian tube or an irregular structure can make it harder for eggs to travel through them. This may increase the risk of an embryo implanting outside of the womb.
- Previous surgery: Having a past cesarean delivery or fibroid removal increases the risk of an ectopic pregnancy.
It is possible for a person to have an ectopic pregnancy without any of these risk factors. In fact, up to one-half of all diagnosed ectopic pregnancies occur in people who have no known risk factors.
Diagnosing an ectopic pregnancy can be difficult because the early symptoms can resemble those of other health issues.
First, a healthcare professional assesses the symptoms and tests for pregnancy. They then order a transvaginal ultrasound to confirm the diagnosis. This involves using sound waves to produce images of the uterus and surrounding areas.
If it is too early to detect an ectopic pregnancy, the doctor may order blood tests to monitor the person’s condition. This will continue until the doctor can confirm or rule out the ectopic pregnancy.
The options depend on the progression of the pregnancy and any complications that may have developed.
Surgery
A surgeon may perform a laparoscopy, a type of keyhole surgery, to remove the ectopic pregnancy. It involves making a small incision in or near the navel and inserting a small camera and a thin tool.
If the ectopic pregnancy causes a fallopian tube rupture, a surgeon will perform emergency surgery to repair the damage. If this is not possible, they will remove the tube.
Drug therapy
When a healthcare professional diagnoses an ectopic pregnancy early, drug-based treatment may be an option.
This may involve methotrexate, a drug that stops the cells of an embryo from rapidly dividing and growing. Adverse effects of methotrexate can include nausea, vomiting, abdominal pain, and possibly mouth sores.
It is not possible to prevent an ectopic pregnancy, and up to one-half of these pregnancies occur in people with no prior risk factors.
However, a person can reduce their risk of PID, which can damage the fallopian tubes and increase the risk of an ectopic pregnancy.
STIs, such as chlamydia and gonorrhea, are a cause of PID. Using barrier methods of protection during sex, such as condoms, can help prevent the transmission of these infections.
Quitting smoking may also reduce the risk of an ectopic pregnancy.
Anyone who has had an ectopic pregnancy has an increased risk of experiencing this again. It is important for someone in this situation to use a reliable form of birth control until they are ready to conceive, particularly if one fallopian tube has been removed.
It is important to let doctors know about past ectopic pregnancies. This can help them detect any future ectopic pregnancy more quickly.
An ectopic pregnancy occurs when an embryo settles in tissue outside of the womb, often in a fallopian tube. Without swift treatment, this can cause life threatening complications for the pregnant person. Treatment cannot preserve the pregnancy, however.
The symptoms of an ectopic pregnancy may begin as early as week 4 and as late as week 12. Diagnosing the issue may involve a combination of pregnancy tests, symptom assessment, and ultrasound imaging.
Receiving an early diagnosis can reduce the likelihood of complications, including fallopian tube damage and internal bleeding. The treatment may involve surgery, but a drug-based treatment may be an option when a doctor detects an ectopic pregnancy early.
Last medically reviewed on August 11, 2021
- Pregnancy / Obstetrics
- Women's Health / Gynecology
- Parenthood
An ectopic pregnancy is when a fertilised egg implants itself outside the womb, usually in one of the fallopian tubes. This means the embryo will not be able develop into a baby as the fallopian tube is not large enough to support the growing embryo.
In a few cases an ectopic pregnancy causes no noticeable symptoms and is only detected during routine pregnancy testing. However, most women do have symptoms and these usually become apparent between week 4 and week 12 of pregnancy.
Early diagnosis and treatment is important to prevent life-threatening bleeding and also, if possible, so the tube can be saved and it can continue to work.
Symptoms of ectopic pregnancy
If you have an ectopic pregnancy, you might experience:
One-sided abdominal pain — typically on one side of your abdomen (tummy), which can be persistent and severe.
Vaginal bleeding — vaginal bleeding is a different type of bleeding from your regular period. It often starts and stops, and can be bright or dark red in colour. Some women mistake this bleeding for a regular period and do not realise they are pregnant.
Shoulder tip pain — shoulder tip pain is felt where your shoulder ends and your arm begins. It is not known exactly why shoulder tip pain occurs, but it usually occurs when you are lying down and is a sign that the ectopic pregnancy is causing internal bleeding. The bleeding is thought to irritate the phrenic nerve, which is found in your diaphragm (the muscle used during breathing that separates your chest cavity from your abdomen). The irritation to the phrenic nerve causes referred pain (pain that is felt elsewhere) in the shoulder blade.
Bowel pain — you may experience pain when passing urine or stools.
Diarrhoea and vomiting — an ectopic pregnancy can cause similar symptoms to a gastrointestinal disease and is often associated with diarrhoea and vomiting.
How is ectopic pregnancy diagnosed?
It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions.
Some of the tests used to diagnose an ectopic pregnancy include:
- vaginal ultrasound
- blood tests
- keyhole surgery
How is an ectopic pregnancy treated?
If an ectopic pregnancy is detected at an early stage, a medication called methotrexate is sometimes needed to stop the egg developing. The pregnancy tissue is then absorbed into the woman's body.
Methotrexate is not always needed, as in around half of cases the egg dies before it can grow larger.
Ectopic pregnancies detected at a more advanced stage will require surgery to remove the pregnancy sac.
If an ectopic pregnancy is left to develop, there is a risk that the fertilised egg could continue to grow and cause the fallopian tube to split open (rupture), which can cause life-threatening internal bleeding.
Signs of a ruptured fallopian tube are:
- sudden, severe, sharp pain
- feeling faint and dizzy
- feeling nauseous or vomiting
- diarrhoea
- shoulder tip pain
A ruptured fallopian tube is a medical emergency. If you think that you or someone in your care has experienced this complication, call 000 and ask for an ambulance.
Why does an ectopic pregnancy happen?
In a normal pregnancy an egg is fertilised by sperm in one of the fallopian tubes, which connect the ovaries to the womb. The fertilised egg then moves into the womb and implants itself into the womb lining (endometrium), where it grows and develops.
An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb. It most commonly occurs in a fallopian tube (this is known as a tubal pregnancy), often as the result of damage to the fallopian tube or the tube not working properly.
Less commonly (in around 2 in 100 cases), an ectopic pregnancy can occur in an ovary, in the abdominal space or in the cervix (neck of the womb).
In many cases, it's not clear why a woman has an ectopic pregnancy. Sometimes it happens when there's a problem with the fallopian tubes, such as them being narrow or blocked.
The following are all associated with an increased risk of ectopic pregnancy:
- pelvic inflammatory disease (PID) — an infection of the female reproductive system, typically caused by chlamydia
- smoking
- having a previous history of ectopic pregnancies
- previous surgery on your fallopian tubes — such as an unsuccessful female sterilisation procedure, or other surgery in your pelvis or abdomen
- fertility treatment, such as IVF — taking medication to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy
- becoming pregnant while using an intrauterine device (IUD) or intrauterine system (IUS) for contraception — it's rare to get pregnant while using these, but if you do you're more likely to have an ectopic pregnancy
- becoming pregnant while using the mini (progesterone-only) pill
- having endometriosis
- increasing age — the risk is highest for pregnant women who are aged 35-40
In around half of all cases, there are no obvious risk factors.
Support
The loss of your pregnancy at any stage can have a huge impact on you and your partner. One day you are pregnant and planning your future life with your child, and then within a short time, your pregnancy ends. The ending of an ectopic pregnancy is a form of miscarriage – and the feelings that a woman and her partner may experience can be similarly difficult.
It is not uncommon for feelings of grief and bereavement to last for 6 to 12 months, although these feelings usually improve with time.
Pregnancy, Birth and Baby offers free and confidential support and counselling to women, their partners, friends and relatives. Call on 1800 882 436.
Many women affected by a miscarriage benefit from counselling. SANDS (miscarriage, stillborn and neonatal death support) provide support groups for parents and their family whose baby has died through stillbirth, miscarriage, ectopic pregnancy and medically advised termination.
Information on SANDS groups in Australian states can be obtained from the SANDS Australia website.
Trying for another pregnancy
It is normally recommended that you wait for at least 2 menstrual cycles before trying for another pregnancy, as this will allow time for your fallopian tubes to recover (if treated with methotrexate, you will need to wait at least 3 to 4 months). However, many women are not emotionally ready to try for another pregnancy so soon.
Your chances of having a successful pregnancy will depend on the underlying health of your fallopian tubes.
If you cannot conceive in the normal way then fertility treatment such as in-vitro fertilisation (IVF) may be an option.
IVF treatment is where an egg is fertilised by a sperm outside the womb (usually in a test tube) and, after fertilisation, the embryo is surgically implanted into the womb.
Last reviewed: April 2020