Ectopic means "out of place." In an ectopic pregnancy, a fertilized
egg has implanted outside the uterus. The egg settles in the
fallopian tubes in more than 95% of ectopic pregnancies. This is why
ectopic pregnancies are commonly called "tubal pregnancies." The egg
can also implant in the ovary, abdomen, or the cervix, so you may
see these referred to as cervical or abdominal pregnancies.
None of these areas has as much space or nurturing tissue as a
uterus for a pregnancy to develop. As the fetus grows, it will
eventually burst the organ that contains it. This can cause severe
bleeding and endanger the mother's life. A classical ectopic
pregnancy does not develop into a live birth.
Signs and Symptoms
Ectopic pregnancy can be difficult to diagnose because symptoms
often mirror those of a normal early pregnancy. These can include
missed periods, breast tenderness, nausea, vomiting, or frequent
The first warning signs of an ectopic pregnancy are often pain or
vaginal bleeding. You might feel pain in your pelvis, abdomen, or,
in extreme cases, even your shoulder or neck (if blood from a
ruptured ectopic pregnancy builds up and irritates certain nerves).
Most women describe the pain as sharp and stabbing. It may
concentrate on one side of the pelvis and come and go or vary in
Any of the following additional symptoms can also suggest an ectopic
* vaginal spotting
* dizziness or fainting (caused by blood loss)
* low blood pressure (also caused by blood loss)
* lower back pain
What Causes an Ectopic Pregnancy?
An ectopic pregnancy results from a fertilized egg's inability to
work its way quickly enough down the fallopian tube into the uterus.
An infection or inflammation of the tube might have partially or
entirely blocked it. Pelvic inflammatory disease (PID), which can be
caused by gonorrhea or chlamydia, is a common cause of blockage of
the fallopian tube.
Endometriosis (when cells from the lining of the uterus implant and
grow elsewhere in the body) or scar tissue from previous abdominal
or fallopian surgeries can also cause blockages. More rarely, birth
defects or abnormal growths can alter the shape of the tube and
disrupt the egg's progress.
If you arrive in the emergency department complaining of abdominal
pain, you'll likely be given a urine pregnancy test. Although these
tests aren't sophisticated, they are fast — and speed can be crucial
in treating ectopic pregnancy.
If you already know you're pregnant, or if the urine test comes back
positive, you'll probably be given a quantitative hCG test. This
blood test measures levels of the hormone human chorionic
gonadotropin (hCG), which is produced by the placenta and appears in
the blood and urine as early as 8 to 10 days after conception. Its
levels double every 2 days for the first several weeks of pregnancy,
so if hCG levels are lower than expected for your stage of
pregnancy, one possible explanation might be an ectopic pregnancy.
You'll probably also get an ultrasound examination, which can show
whether the uterus contains a developing fetus or if masses are
present elsewhere in the abdominal area. But the ultrasound might
not be able to detect every ectopic pregnancy. The doctor may also
give you a pelvic exam to locate the areas causing pain, to check
for an enlarged, pregnant uterus, or to find any masses.
Even with the best equipment, it's hard to see a pregnancy less than
5 weeks after the last menstrual period. If your doctor can't
diagnose ectopic pregnancy but can't rule it out, he or she may ask
you to return every 2 or 3 days to measure your hCG levels. If these
levels don't rise as quickly as they should, the doctor will
continue to monitor you carefully until an ultrasound can show where
the pregnancy is.
Options for Treatment
Treatment of an ectopic pregnancy varies, depending on how medically
stable the woman is and the size and location of the pregnancy.
An early ectopic pregnancy can sometimes be treated with an
injection of methotrexate, which stops the growth of the embryo.
If the pregnancy is further along, you'll likely need surgery to
remove the abnormal pregnancy. In the past, this was a major
operation, requiring a large incision across the pelvic area. This
might still be necessary in cases of emergency or extensive internal
However, the pregnancy may sometimes be removed using laparoscopy, a
less invasive surgical procedure. The surgeon makes small incisions
in the lower abdomen and then inserts a tiny video camera and
instruments through these incisions. The image from the camera is
shown on a screen in the operating room, allowing the surgeon to see
what’s going on inside of your body without making large incisions.
The ectopic pregnancy is then surgically removed and any damaged
organs are repaired or removed.
Whatever your treatment, the doctor will want to see you regularly
afterward to make sure your hCG levels return to zero. This may take
several weeks. An elevated hCG could mean that some ectopic tissue
was missed. This tissue may have to be removed using methotrexate or
What About Future Pregnancies?
Some women who have had ectopic pregnancies will have difficulty
becoming pregnant again. This difficulty is more common in women who
also had fertility problems before the ectopic pregnancy. Your
prognosis depends on your fertility before the ectopic pregnancy, as
well as the extent of the damage that was done.
The likelihood of a repeat ectopic pregnancy increases with each
subsequent ectopic pregnancy. Once you have had one ectopic
pregnancy, you face an approximate 15% chance of having another.
Who's at Risk for an Ectopic Pregnancy?
While any woman can have an ectopic pregnancy, the risk is highest
for women who are over 35 and have had:
* a previous ectopic pregnancy
* surgery on a fallopian tube
* infertility problems or medication to stimulate ovulation
Some birth control methods can also affect your risk of ectopic
pregnancy. If you get pregnant while using progesterone-only oral
contraceptives, progesterone intrauterine devices (IUDs), or the
morning-after pill, you might be more likely to have an ectopic
pregnancy. Smoking and having multiple sexual partners also
increases the risk of an ectopic pregnancy.
When to Call Your Doctor
If you believe you're at risk for an ectopic pregnancy, meet with
your doctor to discuss your options before you become pregnant. You
can help protect yourself against a future ectopic pregnancy by not
smoking and by always using condoms when you're having sex but not
trying to get pregnant. Condoms can protect against sexually
transmitted infections (STDs) that can cause PID.
If you are pregnant and have any concerns about the pregnancy being
ectopic, talk to your doctor — it's important to make sure it's
detected early. You and your doctor might want to plan on checking
your hormone levels or scheduling an early ultrasound to ensure that
your pregnancy is developing normally.
Call your doctor immediately if you're pregnant and experiencing any
pain, bleeding, or other symptoms of ectopic pregnancy. When it
comes to detecting an ectopic pregnancy, the sooner it is found, the