Every month, one of your ovaries releases an egg into a fallopian tube. If you don’t get pregnant, the lining of your uterus sheds and your period arrives. But if an egg becomes fertilized with sperm, it makes its way to the uterus and implants into the uterine lining. From there, it continues to develop into a baby.
In approximately 2% of all pregnancies, however, a fertilized egg implants outside of the uterus, usually in a fallopian tube. Known as an ectopic pregnancy, it happens early on — before some women even realize they’re pregnant.[1]
Ectopic comes from the Greek word ektopos, which means “out of place.” And because a fertilized egg has implanted in an incorrect place during an ectopic pregnancy, it can rupture the organ in which it's attached. This can cause severe internal bleeding, which is why ectopic pregnancies require immediate emergency treatment and, sadly, lead to the loss of the pregnancy.
An ectopic pregnancy can be physically and emotionally painful, and you may need to give yourself time to heal and come to terms with the loss. But know that most women who had an ectopic pregnancy go on to have a healthy pregnancy in the future.[2]
What is an ectopic pregnancy?
An ectopic pregnancy (also known as a tubal pregnancy) occurs when a fertilized egg implants outside of the uterus, where it can’t continue to develop normally. About 2% of all pregnancies are ectopic. And more than 90% of ectopic pregnancies occur in one of the fallopian tubes, though they can also happen in the cervix, on an ovary, or in the abdomen.[3]
If the ectopic pregnancy goes unnoticed and continues to grow, it can rupture a fallopian tube and cause severe bleeding. That’s why it’s essential to call your doctor right away if you think you’re experiencing ectopic pregnancy symptoms.
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What are the causes of an ectopic pregnancy?
Ectopic pregnancies often occur because an egg’s movement is slowed or obstructed after fertilization, usually because a fallopian tube is scarred, misshapen, or possibly infected or inflamed. Problems with the development of the fertilized egg or hormonal imbalances may also play a role.[4]
What are the symptoms of an ectopic pregnancy?
Symptoms of an ectopic pregnancy develop between weeks 4 and 12 of pregnancy (or about two to 10 weeks after fertilization). However, an ectopic pregnancy can be hard to diagnose since many signs — including breast tenderness, nausea and fatigue — are similar to common early pregnancy symptoms.
Occasional cramping and slight vaginal spotting are not cause for alarm during pregnancy. But you should contact your practitioner if you experience the following signs of ectopic pregnancy, especially if your symptoms persist or worsen:[5]
- Abnormal light bleeding or brown spotting after a positive pregnancy test
- Other vaginal bleeding that doesn’t occur at the time of your period
- Sharp, crampy abdominal pain, usually in the lower abdomen. It often begins as a dull ache that progresses to spasms and cramps. The pain may be continuous or intermittent, and it may worsen when you move, strain your bowels, or cough.
- Lower back pain
If the ectopic pregnancy goes unnoticed and a fallopian tube or other organ ruptures, you may experience:
- Heavier bleeding
- Increasing and/or severe sharp abdominal pain
- Rectal pressure
- Low blood pressure due to blood loss
- A feeling of faintness, weakness or dizziness due to blood loss
- Shoulder pain, due to the accumulation of blood under the diaphragm
What are the risk factors for an ectopic pregnancy?
Although any woman can develop an ectopic pregnancy, the following conditions are linked with an increased risk:
- Pelvic inflammatory disease
- Sexually transmitted infections (STI) like chlamydia or gonorrhea
- A prior ectopic pregnancy. A woman who's experienced one ectopic pregnancy has about a 10 to 15% chance of having another.
- Endometriosis
- Tubal surgery, including tubal ligation, or having your tubes tied
- Getting pregnant while using an intrauterine device, or an IUD. Using an IUD does not increase your risk of an ectopic pregnancy later on, and an ectopic pregnancy with an IUD is extremely rare — but if you do conceive with an IUD in place, your risk of ectopic pregnancy is higher.
- Smoking
- Being over the age of 35
If you’re at increased risk for ectopic pregnancy, be sure to see your doctor before you start trying to get pregnant, and schedule a visit as soon as you find out you’re expecting.
Ectopic pregnancy tests and diagnosis
A pregnancy that's ectopic is usually diagnosed at about four to six weeks into pregnancy. To determine an ectopic pregnancy, your practitioner might use the following:
- A pelvic exam
- A transvaginal ultrasound, which can pick up an ectopic pregnancy as early as five weeks after your last menstrual period; a wand is placed inside your vagina to check for a developing embryo outside of the uterus.
- Blood tests to check the level of the hormone human chorionic gonadotropin (hCG), the hormone made by the placenta that increases during pregnancy. A lower-than-normal increase in hGC levels may indicate an ectopic pregnancy.
- Other blood tests to check for signs of blood loss
Ectopic pregnancy treatment
Unfortunately, there’s no way to preserve an ectopic pregnancy. But there are several ways your doctor may treat it so that you remain healthy and safe.
Medication
The type of ectopic pregnancy in which a fetal heartbeat isn’t present and a fallopian tube hasn’t ruptured can usually be treated with a drug called methotrexate. This type of medicine keeps cells from growing, so the pregnancy ends and is reabsorbed by the body over four to six weeks.
After one shot of methotrexate, you’ll undergo important follow-up blood tests to ensure hCG levels are decreasing appropriately. If your hCG levels don’t drop by at least 15% between the fourth to seventh day after treatment, a second dose is required.[6]
When taking this medication, it’s important you avoid alcohol, stringent exercise, sex (for at least two weeks), folic acid (in both vitamins and foods), and pain medications like ibuprofen. During the process, the ectopic pregnancy can still rupture, which is why it’s so important to make your doctor’s appointments and follow instructions for care.
Laparoscopic surgery
If your fallopian tube has ruptured or the pregnancy is further along, your practitioner may perform surgery under general anesthesia to remove an ectopic pregnancy. The surgery can be done using a laparoscope (a thin, light-transmitting instrument with a camera) that’s inserted through small incisions in the abdomen (sometimes called “keyhole” surgery).
The camera allows the surgeon to see inside without having to make larger incisions with surgical instruments. In some cases, part or all of the ruptured fallopian tube may need to be removed. You’ll usually be able to leave the hospital within 24 hours after a laparoscopy. It’s not unusual to experience some pain during the one- to two-week recovery time.[7]
Laparotomy
A laparotomy is done when a fallopian tube has ruptured and is causing severe internal bleeding, or when there is extensive scar tissue inside the abdomen and pelvis. In this case, you’d leave the hospital in a day or two, and your recovery time would be about six weeks.
Ectopic pregnancy complications
An ectopic pregnancy is considered a medical emergency. Without early diagnosis and treatment, a fertilized egg can continue to grow in the fallopian tube, leading to a rupture. If a fallopian tube bursts, it can result in severe, life-threatening internal bleeding and shock.
To avoid this dangerous situation, be sure to let your practitioner know right away if you’re experiencing any of the symptoms above that you think may be related to an ectopic pregnancy.
Preventing an ectopic pregnancy
An ectopic pregnancy is very often out of your control. But there are a few ways you can reduce your risk:
- Don’t smoke.
- If you're not currently trying to get pregnant, use condoms to lower your risk of contracting an STI.
- Get tested if you are at risk of contracting an STI, so you can get treated promptly.
- See your doctor for possible treatments if you suffer from endometriosis.
And of course, anytime you’re trying to get pregnant, the best way to stay healthy is to exercise, eat well, and remember to take a daily prenatal vitamin.
Coping with pregnancy loss
An ectopic pregnancy is a loss just like any other miscarriage. No matter how early on a pregnancy loss occurs, the grief you experience is real. You may feel sad, shocked or angry, and recovering emotionally and coming to terms with the loss can take time.
Give yourself grace while you heal. Lean on trusted friends and supportive family members following a pregnancy loss, and consider a support group or grief counseling.
Getting pregnant again after an ectopic pregnancy
Having an ectopic pregnancy should have little bearing on your future fertility. Even if you lost a fallopian tube, the other tube should take over.
If you’d like to try and get pregnant again, make sure to see your practitioner for a checkup and follow-up blood tests first to make sure the pregnancy hormone hCG has dropped to an undetectable level. Your doctor may advise you to wait until you’ve had three to six menstrual cycles before trying to get pregnant again.
Some research has shown that about two-thirds of women treated for ectopic pregnancy conceive and have a healthy pregnancy within two years. On average, about 85% of couples who haven't experienced ectopic pregnancy conceive within one year of trying.
While it’s true that having an ectopic pregnancy does place you at a higher risk for another, you may be able to change several lifestyle factors (such as smoking) to lessen that chance. Talk to your doctor about the possible causes and discuss what you can do to reduce your future risk factors. And again, know that most women who have had an ectopic pregnancy later go on to have a healthy one.
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