What Is an Ectopic Pregnancy?
An ectopic pregnancy happens when a fertilised egg implants somewhere other than the main cavity of the uterus. About 95% of ectopic pregnancies occur in the fallopian tube (tubal pregnancy), but they can also occur in the ovary, cervix, or abdominal cavity. An ectopic pregnancy cannot develop normally, as the fallopian tube cannot stretch to accommodate a growing baby. Without treatment, the growing tissue can cause life-threatening bleeding. Ectopic pregnancy affects about 1-2% of all pregnancies.
Signs and Symptoms
Early symptoms may be subtle or absent. A positive pregnancy test followed by vaginal bleeding or pelvic pain should be evaluated.
Sharp, stabbing pelvic or abdominal pain, often on one side
Vaginal bleeding that may be lighter or heavier than a normal period
Shoulder pain (caused by blood irritating the diaphragm)
Dizziness, weakness, or fainting (signs of internal bleeding)
Pain with bowel movements or urination
Emergency symptoms requiring immediate medical attention: severe abdominal pain, heavy bleeding, extreme dizziness, or fainting. These may indicate rupture.
Risk Factors
Previous ectopic pregnancy (increases risk 10-fold)
Pelvic inflammatory disease (PID) or sexually transmitted infections
Previous tubal surgery, including tubal ligation
Endometriosis
Use of an intrauterine device (IUD) - though IUDs reduce overall pregnancy risk, if pregnancy occurs, ectopic risk is higher
Smoking
Fertility treatments, particularly IVF
Previous abdominal or pelvic surgery
However, half of ectopic pregnancies occur in women with no known risk factors.
Treatment Options
Expectant management: In very early ectopic pregnancies with declining hormone levels, careful monitoring without intervention may be appropriate for some women.
Methotrexate: A medication injection that stops cell growth, allowing the body to absorb the ectopic tissue. Used when the ectopic is detected early and has not ruptured. Requires follow-up blood tests and waiting before trying to conceive again.
Laparoscopic surgery: Keyhole surgery to remove the ectopic pregnancy. Sometimes the fallopian tube can be preserved (salpingostomy); other times the tube must be removed (salpingectomy). This is the treatment if rupture has occurred or is imminent.
Emergency surgery: If rupture occurs, emergency surgery is needed to stop internal bleeding and remove the ectopic pregnancy.
Future Fertility After Ectopic
Most women who have an ectopic pregnancy can conceive again and have healthy pregnancies. Your fertility outlook depends on your overall reproductive health and whether your fallopian tubes were affected. If both tubes are healthy or only one was affected, the chance of future normal pregnancy is about 60-80%. The risk of another ectopic is about 10-15%, so early monitoring in future pregnancies is important. If tubes are severely damaged, IVF bypasses the tubes entirely and can help you conceive. Early prenatal care with an early ultrasound to confirm pregnancy location is recommended after an ectopic.
Emotional Recovery
An ectopic pregnancy is a pregnancy loss, and you may experience grief similar to miscarriage. The emergency nature and potential surgery can add trauma to the experience. Give yourself time to grieve and recover physically and emotionally. Seek support from partners, family, friends, or counsellors. Many women experience anxiety in subsequent pregnancies, which is normal. Your medical team can offer extra support and monitoring. Connecting with others who have experienced ectopic pregnancy can help you feel less alone.