Ectopic pregnancy

What is an ectopic pregnancy?

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

Once an egg is fertilized, it usually travels down a fallopian tube and attaches to the lining of your uterus (also called 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 embryo 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 the embryo to grow.

Without treatment, an ectopic pregnancy can cause the place where it’s attached to bleed heavily or burst. This can lead to serious bleeding and even death in the pregnant women. An ectopic pregnancy always ends in pregnancy loss. About 1 in 50 pregnancies (2 percent) in the United States is ectopic.

What are the signs and symptoms of ectopic pregnancy?

Signs of a condition are things someone else can see or know about you, like you have a rash or you’re coughing. Symptoms are things you feel yourself that others can’t see, like having a sore throat or feeling dizzy. 

An ectopic pregnancy may start out with usual signs and symptoms of pregnancy, like missing your period or having nausea (feeling sick to your stomach) or tender breasts. Or you may not have any signs or symptoms and not even know you’re pregnant.

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

• Bleeding from the vagina
• Feeling faint or dizzy. This can be caused by blood loss which can cause low blood pressure. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body.
• Pain in your lower back pain or even your shoulder
• Pain in your pelvic area (the part of your body between your stomach and legs). This pain may be mainly on one side. It can come and go, start out mild and then become sharp and stabbing.

How is an ectopic pregnancy diagnosed?

Your health care 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 (also called 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. During an ultrasound, your health care provider uses a wand-like tool called a transducer on your belly (also called a transabdominal ultrasound) or inside the vagina (also called a transvaginal ultrasound). Providers often use transvaginal ultrasound to find an ectopic pregnancy because it can show a pregnancy earlier than a transabdominal 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 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:

• Are older than 35
• Smoke
• Have more than one sex partner. This can put you at risk for getting a sexually transmitted infection (also called STI). An STI is an infection you can get from having sex with someone who is infected. STIs can lead to pelvic inflammatory disease (also called PID), an infection that can damage the fallopian tubes, uterus and other organs.

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

• You‘ve had a previous ectopic pregnancy.
• You’ve had surgery on a fallopian tube, or you have problems, like 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.
• You have scars inside the pelvic area from a (ruptured) burst appendix or from past surgeries. Your appendix is part of your digestive tract that helps you process the food you eat.
• You’ve had endometriosis. This is when tissue from the uterus grows somewhere outside the uterus.
• You had trouble getting pregnant, or you had fertility treatment to help you get pregnant.
• You got pregnant while using an intrauterine device (also called IUD) or after tubal ligation (also called having your tubes tied). An IUD is a form of birth control that your provider places inside your uterus. Tubal ligation is surgery to close the fallopian tubes to prevent you from getting pregnant.

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.

More information:

From hurt to healing (free booklet from the March of Dimes for grieving parents)

Share Your Story (March of Dimes online community for families to share experiences with prematurity, birth defects or loss)

Centering Corporation (general grief information and resources)

Compassionate Friends (resources for families after the death of a child)

Journey Program of Seattle Children’s Hospital (resources for families after the death of a child)

Share Pregnancy & Infant Loss Support (resources for families with pregnancy or infant loss)

Last reviewed: October, 2017