Ectopic pregnancy

An ectopic pregnancy happens when a fertilised egg implants in the wrong place (usually the fallopian tube). It happens at the very start of pregnancy. It is sometimes called a ‘tubal pregnancy’.

Ectopic pregnancy is often a difficult and painful experience. As well as grieving the loss of your baby, you may have had to cope with emergency surgery and perhaps the loss of a fallopian tube. We hope the information on this page helps you make sense of what has happened and the support available.

On this page:

How does an ectopic pregnancy happen?

Causes of ectopic pregnancy

Symptoms of an ectopic pregnancy

Where can I get medical help?

How is an ectopic pregnancy diagnosed?

Pregnancy of unknown location (PUL)

Treatment for ectopic pregnancy

Planning another pregnancy after ectopic pregnancy

Feelings and emotions after ectopic pregnancy

How does an ectopic pregnancy happen?

Usually, when the ovary releases an egg, it travels along a fallopian tube where it can meet a sperm and be fertilised. The fertilised egg should move into the womb and implant there. It can then start to develop into an embryo. 

If the fertilised egg implants in the wrong place, the pregnancy is ectopic. Ectopic means 'out of place'.  

In 95-97 out of 100 cases of ectopic pregnancy the fertilised egg implants in the fallopian tube. Sometimes it implants in the ovary, cervix, abdomen, or even a caesarean scar. Sadly, the pregnancy can’t survive as it’s not in the right place to develop. 

Ectopic pregnancy can be life-threatening. This is because the growing baby can rupture the tube, causing internal bleeding. 

Causes of ectopic pregnancy

Ectopic pregnancy does not happen because of anything you did or didn’t do. But research shows there are some things that might make an ectopic pregnancy more likely.

The main risk factor is if you have damaged fallopian tubes. Damage might have been caused by a past infection or pelvic surgery. Or it may be because your fallopian tubes have developed in slightly the wrong way from the start.

If you use an IUD (coil) for contraception, but you get pregnant anyway, the pregnancy is more likely to be ectopic than without one. 

If you are over 35, your risk of having an ectopic pregnancy rises from 2 out of 100 (under 35) to 4 out of 100 (over 35).

Black women and birthing people have an increased risk of ectopic pregnancy. We don’t know why. More research is needed. See our page on the risk of miscarriage in Black and Black Mixed Heritage women and birthing people.

1 in 3 women and birthing people who have an ectopic pregnancy will have no risk factors at all.

Symptoms of an ectopic pregnancy

It’s not always straightforward to diagnose an ectopic pregnancy as symptoms can vary a lot. There are some common symptoms you can look out for. They are most common around the 6th week of pregnancy but can appear anywhere between 4 and 12 weeks of pregnancy.

• Pain in your lower stomach. This may develop suddenly or come on over several days. The pain may be on one side of your tummy or can be on both sides.
• Vaginal bleeding, which may be darker than usual.
• Upset stomach and sudden diarrhoea.
• Pain when you poo or pee.

Get emergency medical help if you have any of these symptoms.

• Severe pain in your stomach (abdomen). A burst (ruptured) fallopian tube can cause internal bleeding and intense abdominal pain.  
• Pain in the tip of your shoulder. This pain is there all the time and may be worse when you are lying down. It is not relieved by movement. Painkillers may not help either.  
• Dizziness / fainting / collapse.

Where can I get medical help?

You should call 999 or go to A&E if you have:

• severe tummy pain and/or  
• dizziness/ fainting/collapse
• and/or pain in the tip of your shoulder. 

If you have one or more of the other symptoms above, go to your nearest Early Pregnancy Assessment Unit (EPAU), contact your GP or midwife or call NHS 111.  

How is an ectopic pregnancy diagnosed?

In an emergency, an ectopic pregnancy should be diagnosed and treated quickly. In other cases, it can take up to a week or more. Your GP, an EPAU or hospital will carry out these tests. 

• Pregnancy test. If you have not done a pregnancy test already, you will be asked for a sample of your urine.  
• Physical examination. A doctor will examine your stomach and may also ask to do a vaginal (internal) exam.  
• Ultrasound scan. More than 7 in 10 ectopic pregnancies are diagnosed with a transvaginal scan. A slim probe is gently inserted into your vagina. The sonographer will take a detailed look at your fallopian tubes, womb and other organs. This can help them find out where the pregnancy is.  

Pregnancy of unknown location (PUL)

Sometimes a pregnancy can’t be seen on the ultrasound scan, even if you have had a positive pregnancy test. This is called a ‘pregnancy of unknown location’ (PUL). The pregnancy could be:  

• ectopic  
• in the right place but very small
• or you may have had a miscarriage already.

To find out what has happened, further tests are carried out. Blood tests may be done 48 hours apart to look for changes in pregnancy hormones. These can help tell if the pregnancy is ectopic, but it can be difficult to get a definite diagnosis.  You may be offered further transvaginal ultrasound scans and blood tests.

Treatment for ectopic pregnancy

The treatment you are offered will depend on different things, including:  

• how many weeks pregnant you are,  
• your symptoms,  
• the results of any scans and blood tests,  
• how much pain you are in,  
• your pregnancy hormone levels and how they are changing,  
• the options available at your local hospital,
• your own preference. 

In most cases, you can plan your treatment. Your healthcare team will discuss your options with you. They should explain the pros and cons of each option and answer any questions you might have. 

If your fallopian tube is ruptured, you will need emergency surgery. This is because of the risk of severe bleeding which could be life-threatening. 

Expectant management (wait and see) 

You may be able to wait and see if the ectopic pregnancy ends by itself (expectant management). You are likely to have some vaginal bleeding after the ectopic pregnancy ends. Use pads or period pants rather than tampons or menstrual cups.  

Your healthcare team will check your pregnancy hormone levels to decide if this option is safe for you. They will continue to monitor you throughout expectant management.  

If your ectopic pregnancy does not end by itself, your doctor will talk to you about the options below.  

Medical treatment

During medical treatment, a drug (methotrexate) is injected into your buttock. This stops your pregnancy from growing.  After the pregnancy has ended, you are likely to have some vaginal bleeding. 

Most women only need 1 injection of methotrexate. 15 in 100 women and birthing people need a second injection. 29 out of 100 women and birthing people may need surgery even after medical treatment. This is more likely if your pregnancy is beyond the very early stages. It may also happen if your pregnancy hormone levels are very high. 

You may need to stay in hospital overnight after your injection. You may also need more blood tests until your hormone levels show the pregnancy has ended. 

Treatment of ectopic pregnancy with methotrexate is not known to affect your ability to produce eggs. 

If treatment is successful, it means you will not need to have your fallopian tube removed. 

Surgical treatment 

There are two types of surgery for ectopic pregnancy. Both are carried out under general anaesthetic.

• Keyhole surgery (known as laparoscopy).  
• Open surgery (known as a laparotomy). This is done through a larger cut in your abdomen. You may need open surgery if doctors suspect you have severe internal bleeding.

The aim of surgery is to remove the ectopic pregnancy. The type of operation you have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation.  

Your surgeon may remove a damaged tube if the other one looks healthy. This is known as a salpingectomy. This reduces your risk of having another ectopic pregnancy in the future. 

You can read more about PUL and these management options on the Ectopic Pregnancy Trust website or in the RCOG Ectopic Pregnancy patient information leaflet.  

Planning another pregnancy after an ectopic pregnancy

The chances of having a successful pregnancy after an ectopic pregnancy are good. 65 out of 100 women and birthing people are healthily pregnant within 18 months after an ectopic pregnancy. Even with 1 fallopian tube, many women and birthing people go on to conceive again. The remaining fallopian tube can ‘pick up’ an egg from the opposite ovary. 

You may feel ready to conceive again immediately, or it may be longer until you feel ready. In some cases, there are also medical reasons to wait.  

If you have had medical management, you will need to wait for at least 3-6 months before trying again. Check with your medical team as the recommended time can sometimes vary.  

If you had surgical management, it is recommended to wait until you have had two periods. Talk to your healthcare team if you are not sure.  

Contact your GP or EPAU as soon as you know you are pregnant again. Your EPAU can book you and arrange any early checks you might need. You may be offered an ultrasound scan at around 6 weeks to make sure that the pregnancy is in your womb (uterus). 

You may find it helpful to have a look at our information on pregnancy after miscarriage, ectopic and molar pregnancy.

Your feelings and emotions

Everyone responds to pregnancy loss differently. You may feel grief and loss as well as anxiety about possible future pregnancies.  

You might also be recovering from surgery and coming to terms the realisation that your life was in danger too.  

If you feel you need further support after the loss, talk to your GP or the Ectopic Pregnancy Trust. Our information on feelings and emotions after miscarriage may also be useful.

You might also find it helpful to look at our Facebook support groups for baby loss and pregnancy after loss.

You can also talk to a Tommy’s midwife for free. You can call them on 0800 0147 800, 9am-5pm, Monday-Friday. Or you can email them at [email protected].  Our midwives are specialists who can support you with any aspect of pregnancy loss that would be helpful for you.