Ectopic pregnancy

An ectopic pregnancy grows outside the womb, usually in a fallopian tube. It cannot be moved into the womb or continue to birth. If a tube ruptures, internal bleeding can be life-threatening and needs emergency surgery.

Symptoms that need action now

Call 999 now (UK) or 911 (US), or your local emergency number, if pregnancy is possible and you have sudden severe tummy pain, shoulder-tip pain, marked weakness or fainting. Shoulder pain is among the warning signs ACOG says need emergency assessment.

Contact your GP or NHS 111 in the UK, your obstetric clinician in the US, or your local urgent pregnancy service today for lower tummy pain on one side or vaginal bleeding when pregnancy is possible. Do this even if you have not had a positive pregnancy test. Symptoms alone cannot tell you where a pregnancy is growing.

An ectopic pregnancy does not always cause symptoms at first. When symptoms occur, bleeding may come with a brown watery discharge or discomfort when peeing or pooing. If you are pregnant and bleeding heavily, or bleeding with severe pain, shoulder pain or faintness, use emergency care.

How the pregnancy is checked

Assessment may include an examination, an ultrasound scan to look for the pregnancy and blood tests for the pregnancy hormone hCG. You may need repeat visits, scans and blood tests. Ask the team what to watch for between appointments and how to reach them if anything changes.

Known risk factors include a previous ectopic pregnancy, past fallopian tube surgery, pelvic infection and fertility treatment. But ectopic pregnancy also occurs in people without known risk factors. A lack of past problems is not a reason to delay assessment.

The main approaches to care

Your clinician will discuss which options are suitable, based on your symptoms and test results. NHS guidance includes expectant management: close monitoring to see whether the pregnancy resolves, with further treatment if needed. You need an assessment first and an agreed plan for medical follow-up.

Treatment with medicine usually involves methotrexate to stop the pregnancy growing. It is suitable only in some circumstances, and you must be able to attend follow-up blood tests. Your doctor can explain the treatment, interactions and precautions. Ask about medicines, supplements, alcohol and plans for another pregnancy before leaving.

Surgery removes the pregnancy and may also involve removing the affected fallopian tube. Emergency surgery is needed if rupture has occurred. When there is time to discuss the decision, ask what the proposed operation involves and what it may mean for future fertility.

In the US, ACOG’s patient information focuses on medicine and surgery. It advises follow-up after either treatment. The risk of rupture continues during methotrexate treatment until treatment is complete, so new severe symptoms still need urgent care.

Recovery, grief and another pregnancy

An ectopic pregnancy can be traumatic, including when the pregnancy was unplanned. You may be recovering from treatment while also dealing with loss. Ask your GP or pregnancy team in the UK, or your doctor elsewhere, about counselling. A partner can ask for support too.

Many people can become pregnant again, including after removal of a fallopian tube, but the chance of another ectopic pregnancy is increased. If you want another pregnancy, discuss when it is appropriate after the treatment you have had. Tell your clinician promptly if you become pregnant so an early scan can check its location.

For urgent mental health support, call NHS 111 and select the mental health option in England, or contact your local urgent mental health service elsewhere. In the UK, you can call Samaritans on 116 123. In the US, call or text 988.

Call 999 now (UK) or 911 (US), or your local emergency number, if you cannot keep yourself safe or there is immediate danger to life.