First signs of a tubal pregnancy

Ectopic pregnancy - Symptoms - NHS

Symptoms of an ectopic pregnancy usually develop between the 4th and 12th weeks of pregnancy.

Some women don't have any symptoms at first. They may not find out they have an ectopic pregnancy until an early scan shows the problem or they develop more serious symptoms later on.

Main symptoms

You may have an ectopic pregnancy if you miss a period, have a positive pregnancy test, and have other signs of pregnancy.

Contact your GP or call NHS 111 if you have a combination of any of these symptoms and you think you might be pregnant – even if you haven't had a positive pregnancy test.

Vaginal bleeding

Vaginal bleeding tends to be a bit different to your regular period. It often starts and stops, and may be watery and dark brown in colour.

Some women mistake this bleeding for a regular period and don't realise they're pregnant.

Vaginal bleeding during pregnancy is relatively common and isn't necessarily a sign of a serious problem, but you should seek medical advice if you experience it.

Tummy pain

You may experience tummy pain, typically low down on one side. It can develop suddenly or gradually, and may be persistent or come and go.

Tummy pain can have lots of causes, including stomach bugs and trapped wind, so it doesn't necessarily mean you have an ectopic pregnancy.

But you should get medical advice if you have it and think you might be pregnant.

Shoulder tip pain

Shoulder tip pain is an unusual pain felt where your shoulder ends and your arm begins.

It's not known exactly why it occurs, but it can be a sign of an ectopic pregnancy causing some internal bleeding, so you should get medical advice right away if you experience it.

Discomfort when going to the toilet

You may experience pain when going for a pee or poo. You may also have diarrhoea.

Some changes to your normal bladder and bowel patterns are normal during pregnancy, and these symptoms can be caused by urinary tract infections and stomach bugs.

But it's still a good idea to seek medical advice if you experience these symptoms and think you might be pregnant.

Symptoms of a rupture

In a few cases, an ectopic pregnancy can grow large enough to split open the fallopian tube. This is known as a rupture.

Ruptures are very serious, and surgery to repair the fallopian tube needs to be carried out as soon as possible.

Signs of a rupture include a combination of:

a sharp, sudden and intense pain in your tummy
feeling very dizzy or fainting
feeling sick

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you experience these symptoms.

Page last reviewed: 23 August 2022
Next review due: 23 August 2025

What Is Ectopic Pregnancy? Tubal Pregnancy

What is an ectopic pregnancy?

An ectopic pregnancy happens when a fertilized egg grows outside the uterus.

In a normal pregnancy, a fertilized egg implants and grows in the uterus (also called the womb). In an ectopic pregnancy, the fertilized egg doesn’t make it to the uterus. It implants somewhere else, most often in the fallopian tube. This is called a “tubal pregnancy.” It can also occur in the ovary, cervix, or abdomen.

An ectopic pregnancy can be dangerous for the mother. As the pregnancy grows, it could cause the organ it is implanted in to rupture (burst). This can cause major internal bleeding. That’s why it is important to find an ectopic pregnancy in its early stages.

Symptoms of an ectopic pregnancy

The early signs of an ectopic pregnancy are like those of a normal pregnancy:

Missed periods
Tender breasts
Nausea
Vomiting
Fatigue
Frequent urination
A positive home pregnancy test

The first warning signs of ectopic pregnancy may include:

Abnormal vaginal bleeding
Low back pain
Mild pain in the abdomen or pelvis
Mild cramping on one side of the pelvis

If you have any of these symptoms, you should call your doctor.

As an ectopic pregnancy grows, it may rupture. Then you may experience more serious symptoms. These could include:

Sudden, severe pain in the abdomen or pelvis
Shoulder pain
Feeling weak, faint, or dizzy

If you experience these symptoms, get medical help right away.

What causes an ectopic pregnancy?

Usually, an ectopic pregnancy happens because the fertilized egg wasn’t able to move down the fallopian tube quickly enough. An infection or inflammation in the tube can cause it to be partially or completely blocked. This is commonly caused by pelvic inflammatory disease (PID).

Another common reason tubes get blocked is endometriosis. This is when cells from the lining of the uterus grow outside the uterus. The cells can grow inside the fallopian tube and cause blockages. Scar tissue from previous abdominal surgery or fallopian tube surgery can also block the tube.

Any pregnancy can be an ectopic pregnancy. But you’re more likely to have one if:

You are older than 35 years of age.
You have had infections (such as pelvic inflammatory disease) or operations in the pelvic area.
You have endometriosis.
You’re using assisted reproductive methods to become pregnant, such as in vitro fertilization (IVF).
You smoke.
You have a history of inflammation of the fallopian tubes or abnormally shaped fallopian tubes.
You have had trouble getting pregnant or have had fertility treatment.
You have had an ectopic pregnancy in the past.

How is an ectopic pregnancy diagnosed?

Ectopic pregnancies can be hard to diagnose because the first symptoms are the same as those of a normal pregnancy. If your doctor thinks you may have an ectopic pregnancy, he or she may do the following:

Perform a pelvic exam to check the size and shape of your uterus.
Order a urine test and a blood test to check your levels of human chorionic gonadotropin (hCG). This is a hormone that is produced by the placenta. If you have an ectopic pregnancy, you may have a low hCG level.
Perform a transvaginal ultrasound. During this procedure, a wand is inserted into your vagina. Sound waves from the wand make pictures of organs in the body. This will allow your doctor to see where the pregnancy is growing.

Can an ectopic pregnancy be prevented or avoided?

You can’t prevent an ectopic pregnancy, but you can try to control your risk factors. Don’t smoke. If you do smoke, plan on quitting before you get pregnant. Before getting pregnant, use a condom when having sex. This can help prevent sexually transmitted infections, such as chlamydia and gonorrhea, which can cause PID.

If you’re at higher risk of having an ectopic pregnancy, talk to your doctor. He or she may take extra steps to detect an ectopic pregnancy early. This could include checking your hormone levels or scheduling an early sonogram.

Ectopic pregnancy treatment

If a pregnancy is ectopic, the egg can’t develop. The ectopic tissue must be removed. This can be done with medicine or surgery.

If an ectopic pregnancy is discovered early, your doctor can give you a shot of medicine called methotrexate. This medicine stops cells from growing and ends the pregnancy. Your body then absorbs the ectopic tissue.

Some ectopic pregnancies require surgery. These include those that aren’t discovered early enough, or that cause a pelvic organ to rupture. Surgery is usually done with laparoscopy. This procedure uses a tiny camera that is inserted into your body through small cuts in your abdomen. Special tools are used to remove the pregnancy. If your fallopian tube or another organ has burst, your doctor may remove that, as well.

Whether you’re treated with medicine or surgery, your doctor will want to see you regularly afterward. He or she will monitor your hCG levels to make sure they go back to normal. This can take several weeks.

Living with an ectopic pregnancy

Whether you’re treated with medicine or surgery, your recovery may take several weeks. You may feel tired and have abdominal pain or discomfort. You also might still feel pregnant for a while. It takes a while for the hCG levels in your body to drop. It will probably take a few cycles before your periods go back to normal.

If you’ve had an ectopic pregnancy, you’re more likely to have another one. You also may have trouble getting pregnant again. You should give yourself time to heal before you try to get pregnant after having an ectopic pregnancy.

Having an ectopic pregnancy can be emotionally hard. You may feel sad, angry, and confused. Talk about your feelings with your partner, a trusted family member, or friend. Allow yourself the chance to Find a family member or friend you can talk to about your feelings. Allow yourself to grieve the loss of a pregnancy.

Questions for your doctor

Could vaginal bleeding in early pregnancy be a sign of ectopic pregnancy?
Where is my ectopic pregnancy located?
What treatment do I need?
Will I need surgery?
I’m having a hard time dealing with my feelings. Is there someone I could talk to or a support group in my area?
I’d like to get pregnant again. Is there anything I can do to minimize my risk of having another ectopic pregnancy?

Resources

National Institutes of Health, MedlinePlus: Ectopic Pregnancy

Ectopic pregnancy - signs, causes, symptoms, treatment and prevention

Ectopic pregnancy

What is an ectopic pregnancy and how does it develop?
Signs and symptoms of an ectopic pregnancy
Causes of an ectopic pregnancy
Diagnosis of an ectopic pregnancy
Treatment of an ectopic pregnancy
Consequences of an ectopic pregnancy
Why should you visit the Mama Papa Ya clinic?

After fertilization, the egg moves sequentially along the fallopian tube with the help of cilia of the epithelium and attaches to the inner surface of the uterus. Symptoms of an ectopic pregnancy occur when such implantation occurs outside the surface of the endometrium. This happens in 2% of all conceptions.

What is an ectopic pregnancy and how does it develop?

In this condition, the egg is attached not in the uterus, but in the fallopian tube, on the surface of the peritoneum or cervix. At this time, a home pregnancy test will be positive, but the fetal egg will not be able to fully develop and will inevitably die.

Early symptoms of an ectopic pregnancy are a medical emergency. Prompt treatment reduces a woman's risk of complications and increases her chance of having a baby in the future.

Signs and symptoms of ectopic pregnancy

When a patient develops an ectopic pregnancy, early signs are normal. Observed:

delayed menstruation;
breast tenderness;
fatigue;
nausea;
frequent urination.

Later signs of ectopic pregnancy appear after 6 to 8 weeks of delayed menstruation:

slight discharge of blood from the vagina;
abdominal or pelvic pain.

With further development, the following signs and symptoms of ectopic pregnancy occur:

pain in the lower abdomen, aggravated by movement; at first, it may suddenly appear on one side, and then spread to the entire pelvic area;
severe vaginal bleeding;
soreness during intercourse or gynecological examination;
dizziness or fainting due to internal bleeding;
pale skin, cold sweat, shortness of breath, weak rapid pulse, impaired consciousness (signs of shock).

Causes of ectopic pregnancy

The most common type of pathology is tubal, in which a fertilized egg develops in the fallopian tube. Causes of an ectopic pregnancy in such a case include:

smoking: it interferes with the ability of the fallopian tube to move the fetus into the uterine cavity;
an inflammatory disease such as gonorrhea or chlamydia that has caused scarring in the tubal cavity;
previous fallopian tube operation;
previous ectopic pregnancy.

Risk factors for pathology:

woman's age over 35;
surgery for diseases of the abdominal organs;
multiple abortions;
endometriosis;
malformations of the fallopian tubes;
pregnancy resulting from the use of an intrauterine device.

Diagnosis of ectopic pregnancy

At the beginning of its development, such a pregnancy proceeds as normal, and its termination resembles a spontaneous abortion. How to recognize an ectopic pregnancy? It is very difficult to do this on your own, since such a measureable sign as basal temperature during ectopic pregnancy is not informative - the schedule before the loss of the embryo is the same as during normal gestation.

Diagnosis of ectopic pregnancy is carried out using the following methods:

gynecological examination, revealing the absence of signs of uterine pregnancy and pathological formation, for example, in the tube;
Ultrasound, which makes it possible to determine the pathology from 1 - 2 weeks of delayed menstruation, when a fetal egg is not found in the uterus;
analysis for hCG with an interval of 48 hours, normally the indicator doubles during this time, with an ectopic pregnancy, its increase in the blood is not so great.

Treatment of ectopic pregnancy

A child cannot develop outside the uterus, and the spontaneous interruption of such a pathological process is dangerous for a woman's life. Therefore, the treatment of ectopic pregnancy is only surgical:

salpingostomy - a longitudinal incision of the tube with subsequent restoration of its wall;
salpingectomy - removal of part of the tube when it is ruptured.

Both operations can be performed laparoscopically or laparotomically.

There is also a medical method of treatment - methotrexate. It is used only in the earliest stages when the operation is impossible.

Consequences of an ectopic pregnancy

Usually the consequences of an ectopic pregnancy are relatively favorable: although a woman's ability to conceive is reduced by about 40%, she can still carry and give birth to a child. Another negative factor is the increased risk of recurrence of such a pathology.

Recovery from an ectopic pregnancy occurs during the next menstrual cycle. Much more harm to a woman is brought not by physical, but by psychological trauma. Full rehabilitation requires the support of relatives, communication on appropriate forums, and sometimes individual and group psychotherapy.

The negative consequences of an ectopic pregnancy can be reduced if the causes of the disease are immediately looked for and eliminated.

Why should you visit the Mama Papa Ya clinic?

The network of medical clinics "Mama Papa Ya", whose branches are located in Moscow and other cities, offers medical services at affordable prices that will help to avoid the development of pathology or diagnose it in time:

consultation of a qualified gynecologist on pregnancy planning;
individual pregnancy management program “Waiting for you, baby!”;
tests necessary for expectant mothers, including determining the level of hCG;
gynecological ultrasound for the diagnosis of the disease at an early stage.

All consultations and procedures are carried out at a convenient time for the patient, without waiting and queues.

If you miss your period, we recommend that you take a home pregnancy test and, regardless of the results, make an appointment with a gynecologist. This can be done by calling the nearest clinic or on the website.

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Types

tubal - the embryo develops in the fallopian tubes;
abdominal - the embryo is attached to the walls of the peritoneum;
ovarian - the embryo is attached to the walls of the cervix;
cervical - the embryo is attached to the cavity of the ovary.

Very rare bilateral ectopic pregnancy, as well as heterotopic pregnancy (combination of uterine and ectopic). An ectopic pregnancy of any type is considered a medical emergency.

Let's take a look at tubal pregnancy next, because it is the most common and accounts for 98-99% of all pregnancies outside the uterus.

Signs of ectopic pregnancy

As long as the fetal egg does not overstretch the wall of the fallopian tube, pregnancy is no different from normal and is characterized by standard signs:

delayed menstruation;
positive test;
early toxicosis;
drowsiness;
breast enlargement and soreness;
change in taste preferences.

During menstruation, scanty dark-colored blood discharge is possible. It is impossible for a woman to determine an ectopic pregnancy at home, and diagnostics and specialist advice are required.

Until a certain point, the fertilized egg develops normally. But the embryo grows and it ceases to have enough nutrients. At some point, he ruptures the fallopian tube and bleeding occurs. At the same time, the blood practically does not flow out, only small spotting discharges may appear, the main bleeding occurs in the abdominal cavity.

An ectopic pregnancy may show symptoms after 2 weeks of delayed menstruation. A woman may feel:

weakness, dizziness;
pain in rectum radiating to back;
loss of appetite;
pain in the lower abdomen, sometimes with nausea and vomiting;
scanty spotting.

Particular attention should be paid to pain in the lower abdomen. This symptom is also characteristic of a normal uterine pregnancy. But in a normal pregnancy, the pain is temporary. With tubal, as a rule, the pain increases, intensifies and does not stop.

If you experience any of the symptoms listed, seek medical attention immediately. The condition can worsen sharply at any moment, which threatens the health and life of a woman.

Causes of ectopic pregnancy

Causes are all conditions that disrupt the movement of a fertilized egg into the uterine cavity:

chronic inflammatory processes of the pelvic organs;
violation of patency - the appearance of adhesions and scarring of tissues;
violation of the peristalsis of the fallopian tube
the exit from the pipe is closed;
endometrial pathology;
transferred infectious diseases;
congenital factor - pipes are twisted and very long;
single fallopian tube.

Risk factors:

history of ectopic pregnancy;
adhesive process in the small pelvis;
interventions on the fallopian tubes;
intrauterine contraception;
surgery;
pregnancy after prolonged infertility, after IVF procedure;
anatomical features;
bad habits;
age from 35 years;
hormonal and endocrine disorders.

Diagnosis

It is very difficult to detect a tubal pregnancy during a routine gynecological examination. Methods for diagnosing ectopic pregnancy:

beta-hCG test is the only biochemical indicator for diagnosing ectopic pregnancy. In a normal course, the increase in hCG should double every 2-3 days. Suspicion will be a sluggish increase in hCG, no more than 1.5 times every 2-3 days. A low rise in beta-hCG may be with an undeveloped uterine or ectopic pregnancy;
An early ultrasound of an ectopic pregnancy should be transvaginal to determine where the embryo has attached. It is desirable to carry out for 5-7 days after the delay of menstruation.

Blood progesterone testing is not indicated for the diagnosis of tubal pregnancy. Only according to the beta-hCG data, it is impossible to make a diagnosis, it is necessary to do a transvaginal ultrasound.

Complications

Termination of an ectopic pregnancy usually occurs for 4-6 weeks and develops as a rupture of the tube or as a tubal abortion.

Signs of interruption by type of tube rupture:

delayed menstruation;
intra-abdominal bleeding, characterized by a sharp decrease in blood pressure, pallor, cold sweat, dizziness, fainting, nausea, vomiting;
sharp and very severe pain in the abdomen.

May occur after 6 weeks of pregnancy. An extremely dangerous situation for a woman's life and require immediate surgical intervention.

Signs of interruption by type of tubal abortion:

delayed menstruation;
bleeding from labia;
constant aching, dull pain in the lower abdomen, may radiate to the lower back, groin, rectum.

Tubal abortion proceeds for a long time, without acute manifestations. With detachment of the fetal from the fallopian tube, blood enters the abdominal cavity in small portions and therefore there are no sharp symptoms. On gynecological examination, an increase in the size of the uterus and appendages, pain on palpation of the posterior fornix of the vagina is determined.

What complications can be:

severe bleeding;
repeated ectopic pregnancy;
infertility.

Ectopic pregnancy and consequences

probability of normal pregnancy and childbirth - about 50%;
repeated ectopic pregnancy - about 20%;
15-20% miscarriages;
25% infertility.

Ectopic pregnancy, what treatment is used

If an ectopic pregnancy is suspected, a woman should be urgently hospitalized in a hospital, even if there are no complaints of well-being. The main threat is that the pregnancy can be terminated at any time.

The effectiveness of treatment is determined by timely diagnosis at an early stage and the choice of using laparoscopic access.

In the hospital, after 48-72 hours, repeat ultrasound, determine the level of beta-hCG and conduct a gynecological examination. If the increase in beta-hCG is less than 50% in 48-72 hours and the fetal egg is not detected, then the patient will be shown a diagnostic laparoscopy. Such diagnostics will help not to wait for the rupture of the tube, blood loss and shock.

Currently in Russia, ectopic pregnancy is treated only surgically:

radical (tubectomy) - removal of the tube along with ectopic pregnancy. It is used for rupture or overstretching of the pipe;
organ-preserving (tubotomy) - the tube is cut and the fetal egg is removed. The method is used with timely detection and slight stretching of the pipe.

Only surgery can remove the fetal egg, which is attached outside the uterine cavity. The most common is laparoscopy. The surgeon removes the fetal egg and partially or completely the fallopian tube through small punctures. After 3 days, the woman is allowed to go home.

Opening of the abdominal cavity is usually used when laparoscopic access is difficult (pronounced adhesive process, a large amount of blood in the abdominal cavity, obesity).

The nature of the operation depends on the condition of the woman, the volume of blood loss, location and size of the ovum. With laparoscopic access, the incidence of recurrent ectopic pregnancy is lower than with laparotomy.

Recovering from an ectopic pregnancy

It is important to have a complete examination to understand the cause of an ectopic pregnancy and eliminate it. Observe physical and sexual rest for at least a month after surgery. Measures should be aimed at restoring reproductive function after surgery:

prevention of adhesions - physiotherapy, reflexology, injections of longidase, lidase;
oral contraceptives are recommended for the duration of rehabilitation therapy. As a rule, 6 months after an ectopic pregnancy, you can become pregnant again.

If a tubal pregnancy was diagnosed in time, then the chances of conceiving and bearing a healthy child are quite high. When planning a pregnancy, be sure to consult a doctor.