Ectopic Pregnancy: Causes, Symptoms, Diagnosis, and Treatments

An ectopic pregnancy is when a fertilized egg implants outside your uterus, which can jeopardize your health.

It’s frightening to get diagnosed with an ectopic pregnancy, but getting treatment promptly can mitigate some of the worst risks. Learn all about ectopic pregnancies, including their symptoms, the process of diagnosing them, and what the treatment options are.

Again, unlike a normal pregnancy (where an egg implants and develops inside your uterus), ectopic pregnancies happen when a fertilized egg implants outside of it.

Usually, after an egg gets fertilized by sperm, it travels through the fallopian tube to the uterus. However, in most (97%) ectopic pregnancies, the egg implants in the fallopian tube itself, leading to what’s also called a “tubal pregnancy.” 1 2

An ectopic pregnancy can also occur in other areas, such as your ovaries, cervix, abdomen, uterine cornua (the points where your fallopian tubes attach to your uterus), or even in the scar of a prior C-section. 3 In rare cases, you may even have a heterotopic pregnancy—a twin pregnancy where one baby develops in the womb, but the other one is ectopic. 4

Unfortunately, ectopic pregnancies aren’t viable, which means you’re not going to be able to complete your pregnancy or deliver a live baby. Embryos don’t usually thrive outside of the uterus, and allowing the pregnancy to develop could pose significant risks to your safety.

For example, it could cause your fallopian tube to rupture or burst, which could be life-threatening. To protect your health, your doctor will need to terminate the pregnancy. 5

Ectopic pregnancies in C-section scar tissue

In rare instances, an ectopic pregnancy can technically be viable if the egg implants in the scar of a previous C-section.

However, even though this kind of pregnancy may be viable, it’s very high-risk. Continuing it could lead to serious complications, including organ damage, heavy internal bleeding (hemorrhage), preterm delivery, and even death from a ruptured uterus. 6

For this reason, in the event of an ectopic pregnancy that seems like it could be viable, most doctors will still recommend termination. If you choose to continue, your pregnancy will likely require care at a specialized medical facility (a tertiary care center), and may ultimately require a hysterectomy (removal of the uterus).

Early ultrasounds can identify a C-section scar ectopic pregnancy, so your doctor can start treatment as soon as possible and reduce your risk of complications.

The signs of an ectopic pregnancy can be subtle and may look like the normal early pregnancy symptoms. You may experience: 7

• Nausea (morning sickness)
• Fatigue
• Irregular spotting or bleeding (the most common symptom)
• Abdominal pain
• Swollen breasts
• More frequent urination

Because those symptoms have other potential causes, experiencing them doesn’t necessarily mean you have an ectopic pregnancy.

Serious symptoms that require medical attention

Call your doctor immediately if you notice these more severe warning signs (especially if they’re accompanied by a positive pregnancy test, although it’s still a good idea to get checked out even if you don’t think you’re pregnant).

Signs of blood loss and shock

Fainting might be your first sign of a ruptured ectopic pregnancy. You may also notice that you feel dizzy or weak due to the internal bleeding that happens when your fallopian tube ruptures. Blood loss can result in a weak and rapid pulse (110 beats per minute or more), clammy skin, and confusion. 7

Abdominal, pelvic, or shoulder pain

You may experience sharp pain on one side of your stomach or abdominal cramping, which may either come and go or be constant. 3

It’s a telltale sign of a problem if your pain is not completely relieved when you take pain medication like acetaminophen (Tylenol). 8

You should also let your doctor know if you have pain in the tip of your shoulder, especially when lying down, as this could mean you’ve had internal bleeding from a ruptured ectopic pregnancy. 3 If you have diarrhea, vomiting, and pain when passing stool or peeing, those are also potential warning signs. 9

Vaginal bleeding

If you have any spotting or bleeding other than your regular period, take a pregnancy test. If it is positive, let your doctor know. Blood from an ectopic pregnancy may be darker than what you usually see during your menses, and it could even look like prune juice. 10

There’s no single cause of an ectopic pregnancy; the condition can happen to anyone. With that said, certain factors make you more likely to have one. 1 11

Assisted reproductive technology

Women who are using assisted reproductive technology (ART), such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), have a slightly higher risk of experiencing an ectopic pregnancy. The risk is about 2% to 5% for pregnancies achieved through ART instead of the 1% to 2% of other pregnancies. 3

Age, health, and lifestyle factors

Age can be a risk factor for ectopic pregnancy, with women over 35 having a higher risk compared to younger women. 3

Smoking also elevates your risk (on top of being bad for your health in many other ways). It can lead to a buildup of protein in your fallopian tube that can slow down the fertilized egg when it tries to make its way towards the womb to implant itself.

Taking the morning-after pill and progestin-only hormonal contraceptives may slightly increase your risk. If you use a hormonal or copper intrauterine device (IUD), getting pregnant while it’s in place also increases the likelihood of an ectopic pregnancy. The good news is that this is extremely rare—there’s only a 1% chance of pregnancy of any type while using an IUD. 12

Abnormal fallopian tube

Your risk of an ectopic pregnancy also rises with certain conditions that can cause damage or scarring to your reproductive organ, such as: 2

• A previous ectopic pregnancy: If you had an ectopic pregnancy in the past, you’re statistically more at risk of having one again. 13
• Sexually transmitted infections (STIs): Sometimes, chlamydia and gonorrhea can cause inflammation in the pelvis, also known as pelvic inflammatory disease (PID). This inflammation spreads to the reproductive organs, like the uterus or fallopian tubes, which can damage them. 14 15
• Endometriosis: This condition happens when uterine tissue grows outside the uterus. It can cause inflammation and scarring that may increase your risk of ectopic pregnancy. 16
• Certain surgeries: Because any damage to or scarring in the fallopian tubes makes you more susceptible to an ectopic pregnancy, having previously undergone a procedure like a C-section puts you at a higher risk. Moreover, women who had tubal sterilization procedures or tubal reversal surgery are more at risk. 17

Unfortunately, there’s no surefire way of preventing ectopic pregnancies. That being said, the best thing you can do to lower your risk is to lead a healthy life.

That includes practicing safe sex to guard against sexually transmitted infections (STIs) and avoiding smoking. You should also talk to your doctor if you think you’re at risk (e.g., because you’ve had a previous ectopic pregnancy) so that they can plan treatment accordingly.

To diagnose ectopic pregnancies, doctors use a combination of physical exams, blood tests, and ultrasound imaging. Here’s what you can expect during these tests:

Pregnancy test

To confirm that you’re pregnant, your doctor may perform a few blood tests to check for the pregnancy hormone beta human chorionic gonadotropin (βhCG). You might have several βhCG tests over a few days to monitor your levels.

In a healthy pregnancy, your βhCG levels should double every 48–72 hours. Lower levels than expected (e.g., less than 2,000 mIU/ml) or an unusually slow rise may indicate an ectopic pregnancy. 3

Physical exam

If your doctor thinks they need to check for an ectopic pregnancy, they’ll probably perform a pelvic exam to assess your pain and tenderness, as well as to look for any masses in your abdomen. They’ll also ask you about your risk factors, such as previous ectopic pregnancies, tubal surgeries, or pelvic infections. 1

Ultrasound

A transvaginal ultrasound—where your doctor inserts a probe into your vagina—can give your doctor a detailed view of your uterus and fallopian tubes. This can help determine if a pregnancy is located within your uterus. If your doctor can’t see a pregnancy there, they’ll look for signs in the fallopian tubes or other areas. 18

If you have a positive pregnancy test, but your doctor can’t find where the pregnancy is on an ultrasound, they may diagnose you with a pregnancy of unknown location (PUL). 19

In these cases, you’ll need close monitoring with several hCG tests and ultrasounds necessary to determine if the pregnancy is viable, ectopic, or if a miscarriage has occurred.

Surgery

Your doctor might need to perform a minimally invasive surgery called a laparoscopy (keyhole surgery) if you’re in severe pain or if they can’t diagnose you using the measures discussed above.

A laparoscopy involves making around three to four small cuts in your abdomen and placing a tiny camera inside to look at your fallopian tubes and internal organs. 20 Your doctor will remove the ectopic pregnancy if they can locate it, but sometimes, it may be too small to see.

Unfortunately, an ectopic pregnancy can’t be moved to your uterus. 21 Instead, your doctor has a few different approaches to treating your condition.

Expectant management

Your doctor will carefully assess you to see if the ectopic pregnancy ends by itself without issue (i.e., results in a harmless miscarriage). 22

The “wait and see” approach only works if your health isn’t at risk. Your doctor will first make sure that you’re stable and that your ultrasound doesn’t show any signs of internal bleeding or a large ectopic pregnancy.

They’ll also check if your βhCG levels are low and declining as expected, which indicates that the pregnancy is resolving on its own.

However, it may take between three and six weeks for your hormones to return to their pre-pregnancy levels. 23 You’ll probably have regular blood tests to check your levels while you wait.

Medical management (methotrexate)

If your doctor catches the ectopic early, they may give you a medication like methotrexate. This works by disrupting the folic acid in your body, which stops the growth of the cells in ectopic pregnancy. 24

Usually, you’ll have just one injection. However, you might need a second dose if your next few blood tests throughout the week reveal that your hormones aren’t dropping as expected.

Avoid getting pregnant for the next three months after the injection to prevent further health complications. 24

Surgical management

Unfortunately, you might need surgery if conservative options or medications don’t work for you. There are several types of surgical approaches, including two types of laparoscopy: 1

• Salpingectomy: This entails the removal of the entire fallopian tube. Your doctor may go this route if the fallopian tube containing the ectopic pregnancy is damaged or at risk and the other fallopian tube looks normal, meaning you still have at least one tube remaining. 25
• Salpingotomy: Your doctor may remove the ectopic pregnancy but leave the fallopian tube itself. They’ll probably choose this option if the other tube is missing (for example, from a previous surgery) or if it looks abnormal. The idea is to preserve your fertility by keeping one tube intact. 26

Laparotomy vs. laparoscopy

In emergencies, your doctor may need to make a larger incision in your abdomen to treat your ectopic pregnancy than a laparoscopy entails. This procedure is called a laparotomy. 27 However, these days, this is uncommon; almost all doctors opt for laparoscopies, and generally only opt for the more invasive procedure if there’s significant bleeding.

Around 30% of women who’ve had an ectopic pregnancy may experience difficulty conceiving later on. Normally, your chances of having another one range from 5% to 20%. If you’ve had two consecutive ectopic pregnancies, the risk increases to 32%. 1

However, about 77% of women go on to have successful pregnancies afterward, regardless of the treatment they received. 1

When to try again after an ectopic pregnancy

Give your body and mind time to heal before trying to conceive again. Your doctor will advise you on the appropriate waiting period, which may vary depending on your treatment.

If you get pregnant, let your doctor know as soon as possible so they can monitor your pregnancy from the get-go. If you get an ultrasound scan early on (usually between weeks 7–9), your doctor can confirm the location and see if it’s viable. 18

Being diagnosed with an ectopic pregnancy can be devastating, both physically and emotionally. Look to your partner, family, friends, or a therapist for support. Consider joining a support group for would-be mothers going through similar experiences.

Make sure you keep in regular contact with your doctor, and be kind to yourself. Know that it’s almost never your fault if you have an ectopic pregnancy, and the odds are in your favor if you plan on trying again.