What is an ectopic pregnancy?

Ectopic pregnancy is a serious pregnancy complication wherein an embryo implants outside the uterus. Most often, this occurs in the fallopian tube, but it can also occur in the:

• Cervix
• Ovaries
• Abdomen
• Uterine horns (or uterine cornua, where the fallopian tube meets the uterine cavity)
• Myometrium (the centermost layer of the uterine wall)

Implantation outside the uterus makes the pregnancy non-viable, and without medical intervention, it can cause severe and even fatal consequences for the mother.

If you’re pregnant and notice a possible symptom of ectopic pregnancy, or your doctor has intimated you are at risk, it’s important to seek medical assistance immediately.

Early Signs and Symptoms of Ectopic Pregnancy

The first fundamental symptom of ectopic pregnancy is knowing you are pregnant: if you’ve taken an at-home pregnancy test, the test should read positive. You may also notice signs and symptoms of early pregnancy, like missing your period, noticing enlarged or tender breasts, and experiencing nausea (“morning sickness”).

Once you’ve confirmed a pregnancy, consider these early signs and symptoms that are common in ectopic pregnancy:

• Pelvic or abdominal pain – Experiencing localized pelvic pain or abdominal pain is one of the most common symptoms of ectopic pregnancy, though it’s not consistently reported across all cases. This type of pain tends to begin with cramping or “sharp” pain in the lower belly, then escalates to more frequent, intense pain.
• Light blood flow – Ectopic pregnancy often presents with spotting or mild vaginal bleeding, which some people may attribute to their monthly period if they don’t yet know they’re pregnant. Your doctor or OBGYN can help you rule out implantation bleeding as a possible cause of your vaginal bleeding.
• Digestive disturbances – Discomfort when going to the bathroom, nausea, or changes in your bowel movements may also occur as a result of ectopic pregnancy. This is because inflammation and bleeding can place stress on the rectum, urinary system, and reproductive organs.

Advanced Symptoms of Ectopic Pregnancy

One of the reasons why ectopic pregnancy can be difficult to diagnose is that many of its symptoms mirror those of early pregnancy or even a normal menstrual cycle. If you observe any of these early symptoms and there is any chance you might be pregnant, it’s crucial to take a pregnancy test.

Advanced signs and symptoms of ectopic pregnancy are characterized by an intensification of early symptoms. They include:

• Dizziness or feeling faint, due to blood loss
• Significant bleeding, especially if you know you are pregnant
• Intense pelvic pain, particularly pain that persists or comes in “waves”, or is restricted to one area of the lower abdomen

Some women also experience shoulder or neck pain, which can result from internal bleeding. This can put pressure on the diaphragm and agitate the nerves surrounding it. Shoulder pain is less common with internal bleeding, but it can be a sign of a late-stage ectopic pregnancy.

What to Do If You See Warning Signs of Ectopic Pregnancy

If you’re pregnant and notice either early or late ectopic pregnancy symptoms, do not ignore them and reach out to your care provider or local emergency room. If an ectopic pregnancy progresses, it can lead to the rupture of the fallopian tube and, in severe cases, death.

How do doctors treat ectopic pregnancy?

Before deciding on a treatment for ectopic pregnancy, a healthcare provider must diagnose the condition and make an assessment of its severity. Ectopic pregnancies are diagnosed by reviewing patients’ medical and reproductive history and conducting a thorough physical exam.

If a provider concludes you have an ectopic pregnancy, they will need to intervene immediately. There are two common ectopic pregnancy treatment options:

• Medication – Patients who exhibit low levels of hCG, human chorionic gonadotropin, are usually treated with medication. A single dose is used to halt the embryo’s development and let the body discard the remaining ectopic tissue naturally. However, medication is not an effective treatment for more advanced cases of ectopic pregnancy, which require surgical intervention.
• Surgery – Advanced ectopic pregnancy requires a more invasive surgical procedure, typically either a laparotomy or salpingostomy. During the surgery, a small incision will be made in the pelvic area to remove the embryo and terminate the pregnancy. Sometimes, a portion of the fallopian tube must also be removed.

No matter how it’s treated, ectopic pregnancy can be a scary and even traumatic experience for many women. If your pregnancy was planned, managing your recovery may involve an emotional component. Leaning on loved ones, a therapist, or a spiritual counselor may help you to process whatever emotions come up as you recover.

Practicing the home care methods outlined by your doctor is an equally important part of the recovery process. Your doctor will likely recommend:

• Getting enough sleep
• Resting until you feel well enough to move around (if you’re walking, take breaks!)
• Avoiding exercise and/or strenuous movement
• Avoiding driving or operating heavy machinery for a few days following treatment
• Avoiding sexual activity until your doctor gives you the go-ahead
• Following a laparotomy, regularly but gently washing your surgical wound and avoiding personal care products around the area

Finally, it’s generally best to postpone any family planning efforts until you’ve completed a follow-up appointment and received a go-ahead from your doctor. Healthcare providers typically recommend waiting at least 3 months before trying to conceive again.

Why does ectopic pregnancy occur?

In a normal pregnancy, where implantation occurs in the uterine wall, muscle contractions and cilia (tiny hair-like structures found throughout the body) in the fallopian tubes help move the fertilized egg into the uterus.

Several factors can inhibit or interfere with these movements and thus the migration of the fertilized egg. These include:

• Infection – Inflammation or immunological shifts, like those caused by the STD/STI chlamydia, can cause structural damage to the fallopian tubes.
• Hormonal changes – These include those involved in normal menstrual cycles. Hormonal fluctuations can disrupt the frequency of cilia’s movement, thereby stymying the passage of the egg.
• Surgery – Some women who have had surgery on their fallopian tubes may be at higher risk of ectopic pregnancy.

There are many reasons why ectopic pregnancy can happen, though in some cases, the precise cause remains unclear. Additionally, certain individuals may be more at risk of ectopic pregnancy than others, including:

• People who smoke
• People of advanced maternal age
• People with endometriosis
• People with a history of ectopic pregnancy
• People with a history of pelvic infections
• People who use IUDs
• People who conceived via in vitro fertilization

Can you get pregnant after an ectopic pregnancy?

Many women who experience an ectopic pregnancy go on to have one or multiple healthy pregnancies (and healthy babies to boot!). However, there are two main health risks to be aware of:

• Recurrence – Women who’ve experienced this complication are at higher risk of undergoing another ectopic pregnancy in the future.
• Structural damage – In general, the more advanced an ectopic pregnancy is before it’s treated, the more likely it is that a woman will sustain structural impairment of her reproductive organs. For some women, this could make it more challenging to conceive.

If you’ve sustained structural damage or have had a fallopian tube removed to treat an ectopic pregnancy, it is still possible to get pregnant. Discussing your options with your healthcare provider will give you the knowledge you need to make informed decisions that keep you—and your future family—as safe and healthy as possible.

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