Ectopic Pregnancy: Causes, Symptoms and Risks

The good news is that ectopic pregnancies are rare. However, if they do occur, they require medical attention, so it’s helpful to know about them, just in case. Learn more about what an ectopic pregnancy is, and what an ectopic pregnancy can feel like.

What Is an Ectopic Pregnancy?

In a typical pregnancy that develops normally, a fertilized egg moves through the fallopian tube toward the uterus, where it implants and starts to grow. In an ectopic pregnancy, the fertilized egg implants outside of the uterus, usually attaching itself to the fallopian tube (but occasionally to the ovary, cervix, or other places in the abdomen). These cannot hold a growing embryo, so the pregnancy cannot progress. The chance of an ectopic pregnancy occurring is relatively low, making up just 2 percent of pregnancies. An ectopic pregnancy must be treated, and your healthcare provider will discuss and recommend the best options for you. Following are some of the causes, risks, symptoms, and treatments for this condition.

Causes of an Ectopic Pregnancy

Possible causes of an ectopic pregnancy can include:

• Infection. An infected or inflamed fallopian tube can mean it becomes partially or entirely blocked so the fertilized egg can’t proceed along the tube.

• Scar tissue. The egg may struggle to move through the fallopian tube if scar tissue from an infection or surgery blocks its way.

• The shape of the fallopian tube. Sometimes, if the shape of the fallopian tube is abnormal due to an abnormal growth or a birth defect, the fertilized egg struggles to make its way through.

Risk Factors for an Ectopic Pregnancy

You’re more likely to have an ectopic pregnancy if

• you’re more than 35 years old

• you’ve had a previous ectopic pregnancy

• you’ve had pelvic or abdominal surgery

• you’ve had pelvic inflammatory disease

• you’ve conceived after having a tubal ligation or while an IUD is in place

• you smoke

• you have endometriosis

• you conceived using fertility treatments, or you are using fertility medications.

Signs and Symptoms of an Ectopic Pregnancy

You might be wondering how to tell if you have an ectopic pregnancy, particularly because some of the signs of an ectopic pregnancy are also normal signs of a healthy pregnancy that you might experience in the first trimester. Keep in mind that ectopic pregnancies are rare, and your healthcare provider is the appropriate person to make this diagnosis.

Some women don’t experience any symptoms at all. However, if you do develop symptoms, you will likely notice these signs of an ectopic pregnancy between the 4th and 12th weeks of pregnancy. These can include:

• A sharp pain that comes and goes, and can vary in intensity. Ectopic pregnancy pain may be located in the pelvis, abdomen, or even the shoulder and neck.

• Bleeding that may be heavier or lighter than your normal period. Remember, bleeding in early pregnancy could also be implantation bleeding, so consult your doctor.

• Discomfort when peeing or pooping.

• Weakness, dizziness, or fainting.

These symptoms can start very early in your pregnancy, at a time when you might not know you are pregnant yet or have had a positive pregnancy test.

In some cases, signs of an ectopic pregnancy will first be recognized by your healthcare provider during your first pregnancy scan.

Contact your provider right away if you notice sharp pains that last more than a few minutes, or if you have any bleeding. Go to the hospital ASAP if you have vaginal bleeding along with abdominal or shoulder pain or weakness, dizziness, or fainting.

Diagnosis

Your provider can make an ectopic pregnancy diagnosis by undertaking these kinds of examinations:

• A pelvic exam to assess if there’s any pain, tenderness, or a mass in the abdomen.

• An ultrasound to see where the pregnancy is developing.

• A urine test or blood test to measure hCG levels. If the level of this pregnancy hormone is lower than expected, it could be due to an ectopic pregnancy.

Ectopic Pregnancy Treatment Options

An ectopic pregnancy cannot move itself or be moved to the uterus, and it can’t continue to progress anywhere but in the uterus. That’s why treatment involves ending the pregnancy either by surgery or by medication. Your doctor will explain which option is best for you.

Medication

For an ectopic pregnancy, the most common drug used is methotrexate. This medication stops the cells of the embryo from growing, which ends the pregnancy. Then, over about four to six weeks, your body absorbs the pregnancy tissue. The benefit of this option is that the affected fallopian tube may not need to be removed, and you may be able to avoid surgery. This option may be recommended if the fallopian tube has not ruptured, and if you’re able to return for regular blood tests to check your hCG levels until it is no longer found in your blood. This option may not be available or advisable if you’re breastfeeding or have certain health issues. Methotrexate may be given in one or more doses. The risk of fallopian tube rupture only goes away once treatment is complete, so if you develop symptoms such as sharp abdominal or shoulder pain, or feeling faint or weak, seek medical help right away, as these are potential signs of internal bleeding resulting from a rupture. Side effects of methotrexate may include nausea, vomiting, and vaginal bleeding or spotting. During treatment and until your doctor gives you the all-clear, it's best to avoid heavy exercise, taking vitamins and foods containing folic acid, taking anti-inflammatories like ibuprofen, having sex, and prolonged exposure to the sun.

Surgery

If a fallopian tube has ruptured, emergency surgery is needed, but sometimes surgery may be needed even if a tube hasn’t burst. The ectopic pregnancy may be removed from the tube leaving the tube in place, or the tube—together with the pregnancy tissue—may be removed. Typically, laparoscopic surgery is chosen. This involves small incisions being made in your abdomen while you’re under a general anesthetic. During surgery the pregnancy tissue is removed, and the affected tube is repaired or removed. In a smaller number of cases, a larger incision of the abdomen may be required, usually in cases where the pregnancy is further along, or if a rupture of the fallopian tube is suspected. Your healthcare provider will recommend a course of treatment and explain all the risks and side effects, which can include bleeding and infection following surgery. After surgery, follow-up care is required, and your doctor will closely monitor your recovery, including rechecking your hCG level to make sure the ectopic tissue has been completely removed.

Getting Pregnant After an Ectopic Pregnancy

If you're wondering if you can have a healthy pregnancy after an ectopic pregnancy, your best bet is to speak with your doctor, who will be able to provide you with specific guidance based on your medical history. If the affected fallopian tube has been left intact, there is a good chance you can have a normal pregnancy in the future; also, if one fallopian tube has been removed, an egg and sperm may still join in the other tube, and the fertilized egg may make its way to the uterus. Keep in mind, though, that having had an ectopic pregnancy increases your risk next time, so during future pregnancies, watch out for the signs and symptoms until your doctor confirms the egg has implanted in the right place—your uterus.

Ectopic pregnancies are relatively rare and treatable, but if you notice any symptoms that worry you, consult your provider for reassurance and advice.

How We Wrote this Article

The information in this article is based on the expert advice found in trusted medical and government sources, such as the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. You can find a full list of sources used for this article below. The content on this page should not replace professional medical advice. Always consult medical professionals for full diagnosis and treatment.