Ectopic pregnancy

Most pregnancies end with the birth of a healthy baby. But sometimes things may go wrong, like in an ectopic pregnancy. An ectopic pregnancy always ends in pregnancy loss. And without treatment right away, it can be life threatening for a pregnant women. 

What is an ectopic pregnancy? 

Ectopic means “out of place.” An ectopic pregnancy is when an embryo grows in the wrong place. An embryo is a fertilized egg that results when an egg and sperm combine.

Once an egg is fertilized, it usually travels down one of your fallopian tubes and attaches to the lining of your uterus (also called the womb). Fallopian tubes are the tubes between your ovaries (where your eggs are stored) and the uterus. The uterus is the place inside you where your baby grows. 

In most ectopic pregnancies, the fertilized egg attaches to a fallopian tube before it reaches the uterus. Less often, it attaches to an ovary, the cervix or your abdomen (belly). The cervix is the opening to the uterus that sits at the top of the vagina. These areas don’t have enough space or the right tissue for a baby to grow. 

Without treatment, an ectopic pregnancy can continue to grow and eventually cause whatever it’s attached to bleed excessively or burst. This can lead to serious bleeding and even death in the pregnant woman.

About 1 in 50 pregnancies in the United States is ectopic. 

How do you know if you have an ectopic pregnancy?

An ectopic pregnancy may start out with usual pregnancy signs, like missing a menstrual period or having nausea and tender breasts. Some women have no early signs and may not even know they’re pregnant. 

Call your health care provider right away if you have any of these signs and symptoms of ectopic pregnancy:  

  • Pain in the pelvic area, the part of the body between the stomach and legs. The pain may be mainly on one side. It can start out mild and then become sharp and stabbing.
  • Lower back pain
  • Shoulder pain
  • Bleeding from the vagina
  • Feeling faint or dizzy
  • Low blood pressure

How is an ectopic pregnancy diagnosed?

Your provider may do these tests to look for an ectopic pregnancy:  

  • A pelvic exam 
  • Blood tests to measure the levels of a pregnancy hormone called human chorionic gonadotropin (hCG). An ectopic pregnancy can cause hCG levels to rise more slowly than a healthy pregnancy. 
  • Ultrasound. This test uses sound waves and a computer screen to show a picture of your baby inside the womb. An ultrasound can be done by putting the ultrasound instrument on the your belly (an abdominal ultrasound) or using a wand-like instrument inside the vagina (a transvaginal ultrasound). Providers often use transvaginal ultrasound to find an ectopic pregnancy because it can show a pregnancy earlier than an abdominal ultrasound. 

Your provider may repeat these tests if he thinks you have an ectopic pregnancy but can’t see it. It’s hard to see a pregnancy less than 5 weeks after your last menstrual period.

If you’re having heavy bleeding, your provider may need to do surgery to diagnose an ectopic pregnancy.

How is an ectopic pregnancy treated?

There are two treatments for ectopic pregnancy:  

  1. Medicine. Your provider gives you an injection of medicine called methotrexate to stop the embryo from growing. This treatment works best if the embryo is small and in the fallopian tube.  
  2. Surgery. Your provider removes the embryo with surgical instruments placed through very small cuts in the belly. This type of surgery is called laparoscopic surgery.  

After treatment, your provider regularly checks your hCG levels until they return to zero. This can take a few weeks. If your levels stay high, it may mean that you still have ectopic tissue in your body. If so, you may need more treatment with methotrexate or surgery to remove the tissue.

Who is at risk for having an ectopic pregnancy?

Any woman can have an ectopic pregnancy. But the risk is higher if you: 

Medical conditions that increase your risk for having an ectopic pregnancy include having: 

  • A previous ectopic pregnancy
  • Surgery on a fallopian tube
  • A birth defect in a fallopian tube. A birth defect is a health condition that is present at birth. It can change the shape or function of one or more parts of the body. It can cause problems in overall health, in how the body develops, or in how the body works.
  • Scars inside the pelvic area from a burst appendix or from past surgeries
  • Endometriosis. This is when tissue from the uterus grows somewhere outside the uterus.
  • STDs, like chlamydia and gonorrhea. STDs can lead to pelvic inflammatory disease, an infection that can damage the fallopian tubes, uterus and other parts of the pelvis.
  • Problems getting pregnant or certain treatments to help you get pregnant (also called fertility treatment)
  • A pregnancy after having tubal ligation. This is surgery to close the fallopian tubes to prevent future pregnancies (also called having your tubes tied).
  • A pregnancy when using an intrauterine device (also called IUD). This is a form of birth control that your provider places inside your uterus. 
  • Exposure to DES (diethylstilbestrol) in the womb. DES is a manufactured form of the hormone estrogen that was sometimes given to pregnant women between 1940 and 1971 to prevent certain pregnancy problems. It has been linked to several types of cancer. 

If you’ve had an ectopic pregnancy before, can you go on to have a healthy pregnancy? 

Yes. About 1 in 3 women (33 percent) who have had one ectopic pregnancy go on to have a healthy pregnancy later. If you've had an ectopic pregnancy, you have about a 3 in 20 chance (15 percent) of having another. 

Last reviewed: May, 2014