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How many weeks ectopic 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

Ectopic pregnancy - NHS

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes.

The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a baby and your health may be at risk if the pregnancy continues.

Unfortunately, it's not possible to save the pregnancy. It usually has to be removed using medicine or an operation.

In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year.

Symptoms of an ectopic pregnancy

An ectopic pregnancy doesn't always cause symptoms and may only be detected during a routine pregnancy scan.

If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy.

Symptoms can include a combination of:

  • a missed period and other signs of pregnancy
  • tummy pain low down on one side
  • vaginal bleeding or a brown watery discharge
  • pain in the tip of your shoulder
  • discomfort when peeing or pooing

But these symptoms aren't necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a stomach bug.

Read more about the symptoms of an ectopic pregnancy.

When to get medical advice

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

An ectopic pregnancy can be serious, so it's important to get advice right away.

Your GP will ask about your symptoms and you'll usually need to do a pregnancy test to determine if you could have an ectopic pregnancy.

You may be referred to a specialist early pregnancy clinic for further assessment, where an ultrasound scan and blood tests may be carried out to confirm the diagnosis.

Read more about ectopic pregnancy tests.

When to get emergency help

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you experience a combination of:

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

These symptoms could mean that your fallopian tube has split open (ruptured). This is very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible.

A rupture can be life threatening, but fortunately they're uncommon and treatable, if dealt with quickly. Deaths from ruptures are extremely rare in the UK.

How an ectopic pregnancy is treated

There are 3 main treatments for an ectopic pregnancy:

  • expectant management – you're carefully monitored and 1 of the treatments below is used if the fertilised egg doesn't dissolve by itself
  • medicine – an injection of a powerful medicine called methotrexate is used to stop the pregnancy growing
  • surgery – keyhole surgery (laparoscopy) is performed under general anaesthetic to remove the fertilised egg, usually along with the affected fallopian tube

You'll be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have.

Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant. Talk to your doctor about this.

Read more about treating an ectopic pregnancy.

Help and support after an ectopic pregnancy

Losing a pregnancy can be devastating, and many women feel the same sense of grief as if they had lost a family member or partner.

It's not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.

If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your GP about this.

Support groups for people who have been affected by loss of a pregnancy can also help.

These include:

  • The Ectopic Pregnancy Trust
  • Ectopic Pregnancy Foundation
  • Miscarriage Association
  • Cruse Bereavement Care

Read more about dealing with loss and find bereavement support services in your area.

Trying for another baby

You may want to try for another baby when you and your partner feel physically and emotionally ready.

You'll probably be advised to wait until you've had at least 2 periods after treatment before trying again to allow yourself to recover.

If you were treated with methotrexate, it's usually recommended that you wait at least 3 months because the medicine could harm your baby if you become pregnant during this time.

Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they've had a fallopian tube removed. Occasionally, it may be necessary to use fertility treatment such as IVF.

The chances of having another ectopic pregnancy are higher if you've had one before, but the risk is still small.

If you do become pregnant again, it's a good idea to let your GP know as soon as possible so early scans can be carried out to check everything is OK.

What can cause an ectopic pregnancy?

In many cases, it's not clear why a woman has an ectopic pregnancy. Sometimes it happens when there's a problem with the fallopian tubes, such as them being narrow or blocked.

The following are all associated with an increased risk of ectopic pregnancy:

  • pelvic inflammatory disease (PID) – inflammation of the female reproductive system, usually caused by a sexually transmitted infection (STI)
  • previous ectopic pregnancy – the risk of having another ectopic pregnancy is around 10%
  • previous surgery on your fallopian tubes – such as an unsuccessful female sterilisation procedure
  • fertility treatment, such as IVF – taking medicine to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy
  • becoming pregnant while using an intrauterine device (IUD) or intrauterine system (IUS) for contraception – it's rare to get pregnant while using these, but if you do you're more likely to have an ectopic pregnancy
  • smoking
  • increasing age – the risk is highest for pregnant women aged over 35

You can't always prevent an ectopic pregnancy, but you can reduce your risk by using a condom when not trying for a baby to protect yourself against STIs, and by stopping smoking if you smoke.

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

Ectopic pregnancy - terms, causes, symptoms, signs, diagnosis, treatment (surgery, removal)

Causes

Signs

Diagnosis

Treatment

What to do

Ectopic pregnancy is one of the most dangerous pathological conditions in which the fetus develops outside the uterine cavity. The place of its implantation can be the fallopian (uterine) tubes, as well as other organs of the abdominal cavity and small pelvis.

Termination of an ectopic pregnancy is accompanied by intra-abdominal bleeding and severe complications requiring surgical intervention. nine0003

In the female body, normal gestation is possible only in the uterus, but in practice, the location of the embryo, in addition to the uterus, may vary.

There are several types of ectopic pregnancy: tubal, ovarian, abdominal, cervical and with a location in the rudimentary horn of the uterus.

The sites listed are unfavorable for gestation, so an ectopic pregnancy is terminated at 4 to 8 weeks to prevent serious complications. nine0003

Attached in an atypical place, the vessels of the fetal egg grow into the surrounding tissues. Other organs, besides the uterus, are not able to stretch and form blood vessels for the placenta. As a result, damage to surrounding tissues occurs, exfoliation of the fetal egg, as a result, severe bleeding occurs that threatens the life of the patient.

The appearance of a tubal form of pathology is associated with the presence of obstacles in the movement of a fertilized egg. If the fertilized egg does not reach the uterine cavity, then it is implanted in the fallopian tube. Ectopic fetal development occurs in approximately 2% of cases among all types of pregnancy, of which 9 fall on the tubal form.eight%. Fetal implantation in other parts of the uterus and appendages, as well as in the abdominal cavity, is much less common.

The release of a fertilized egg into the abdominal cavity with further implantation to the omentum, peritoneum or intestine leads to the development of abdominal pregnancy. One of the causes of this pathology may be in vitro fertilization.

In cervical pregnancy, the egg is implanted in the columnar epithelium of the cervical canal. As a result of deep penetration of the embryonic villi into the muscular layer of the cervix, the pregnancy ends in very heavy bleeding. nine0029

Causes of pathology

The development of pregnancy outside the uterine cavity occurs as a result of failures of natural processes that prevent the penetration of a fertilized egg into it. The most common causes of ectopic pregnancy include:

  • previously transferred infectious lesions of the appendages caused by pathogenic microflora;
  • the presence of adhesions in the fallopian tubes;
  • defects in the structure of the genital organs; nine0037
  • installed IUD in the uterus;
  • infantilism;
  • the presence of a tumor in the appendages or uterus;
  • use of assisted reproduction methods;
  • use of hormonal contraceptives;
  • the presence of an inflammatory focus in the pelvic cavity;
  • previous surgical interventions on the appendages;
  • stimulation of the ovulation process;
  • history of abortion; nine0037
  • endometriosis.

Features

It is not possible to determine the pathology at home. In this regard, timely registration can play a decisive role in the correct diagnosis.

At an early stage of development, an ectopic pregnancy has no distinguishing features. As a rule, it is characterized by:

  • absence of menstruation;
  • breast engorgement;
    • nine0036 manifestations or absence of toxicosis;
  • a positive pregnancy test, although in the presence of ectopic pathology it is not pronounced;
  • painful sensations in the lower abdomen with irradiation to the rectal area, as well as "spotting" discharge from the vagina.

Clinical manifestations of fetal development in the fallopian tube

An ectopic pregnancy can have a progressive form, in which case the growing fetal egg penetrates the muscular layer of the fallopian tube, leading to its gradual destruction. The patient has all the symptoms of pregnancy, but there are small bleeding from the genitals. nine0003

Also ectopic pregnancy can be terminated:

  • as a tubal abortion. In this case, there is a partial or complete detachment of the membranes of the embryo from the wall of the tube and its entry into the abdominal cavity. Symptoms of manifestations depend on the severity of bleeding. Characterized by the presence of vaginal discharge in the form of blood clots. A pronounced soreness in the lower abdomen joins. Bimanual examination reveals an increase in the size of the uterus and appendages. Palpation of the posterior vaginal fornix is ​​very painful; nine0037
  • is like a ruptured fallopian tube. May occur after the 6th week of pregnancy. This condition is life threatening due to internal bleeding. Patients complain of very severe pain in the lower abdomen on both sides. There is a protrusion of the posterior fornix of the vagina and a "floating" uterus during a bimanual examination.

How to detect an ectopic pregnancy

In the initial period, it is difficult to diagnose pathology. Symptoms indicate, as a rule, the presence of pregnancy, but there are no signs typical for the pathology. nine0003

Diagnosis is carried out by examining a woman in a gynecological chair, as well as using additional research methods:

  • blood test for B-hCG, which in case of ectopic pregnancy shows a shorter period than it actually is;
  • Ultrasound, which will give more complete information about the development of the fetal egg and its location.

Interrupted tubal pregnancy is accompanied by intra-abdominal bleeding. Typical symptoms of a pipe rupture will be:

  • acute pain in the lower abdomen radiating to the anus, lumbar region, legs;
  • secretion of blood from the genital tract;
  • rapid, weak pulse;
  • sudden drop in blood pressure;
  • loss of consciousness.

Clinical manifestations of an interrupted tubal pregnancy should be differentiated from appendicitis and ovarian apoplexy. When the embryo is located in the cervical region, pregnancy should be distinguished from incomplete abortion and tumors. nine0003

An ectopic pregnancy can be confirmed or denied after ultrasound diagnostics and a blood test for B-hCG.

Treatment

Treatment of ectopic pregnancy is carried out only by surgery. All the efforts of doctors are aimed at maintaining the integrity and function of the fallopian tube, into which the implantation of the fetal egg has occurred. With timely detection of pathology and a small blood loss, a laparoscopic operation is performed.

When localizing the embryo in the tube, the following types of surgical intervention are used:

  • tubotomy (removal of the fetal egg while preserving the tube). In the case of choosing this method, the possibility of recurrence of the pathology is taken into account;
  • tubectomy (excision of the tube) - performed in the presence of severe damage.

The choice of methodology is influenced by the following factors:

  • whether the woman plans to have a child in the future;
  • repeated ectopic pregnancy will require removal of the tube; nine0037
  • whether there is an adhesive process in the small pelvis;
  • change in the structure of the wall of the fallopian tube.

If the blood loss is large, then in order to save a life during an ectopic pregnancy, it is necessary to perform an abdominal operation, in which the fetal egg and tube are removed. Plasma transfusion may be required to restore blood loss. It is important that the remaining second pipe fully retains its function.

How to deal with an ectopic pregnancy

To avoid serious complications that can occur during a pathological pregnancy, a timely visit to an obstetrician-gynecologist will help. Attempts to save the fetus can lead to sad consequences: as a result of a ruptured tube, blood flows into the abdominal cavity, which leads to fatal hemorrhagic shock.

When a patient is diagnosed with an ectopic pregnancy, urgent hospitalization is required to terminate the pregnancy. nine0003

The author of the article:

Shklyar Aleksey Alekseevich

obstetrician-gynecologist, surgeon, KMN, head of the direction "Obstetrics and Gynecology"

work experience 10 years

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Inna

30.12.2021 21:55:20

Clinic

m. Sukharevskaya

Doctor

Shklyar Aleksey Alekseevich

I turned to Shklyar Aleksey Alekseevich I want to express my deepest gratitude to the entire staff of the operating unit Aleksey Alekseevich Shklyar. You are all doctors with a capital letter. I never tire of thanking God for bringing me to you. I came to you on the recommendation of Sorvacheva M.V. We got in touch with the doctor by phone and appointed the day of the operation. For the first time, I was pleasantly surprised how Alexey Alekseevich told me everything in detail and reassured me. A couple of weeks later, I arrived at the clinic at 10.00 with a complete list of tests, and already at 11 I was lying on the operating table, to be honest, I didn’t even have time to get scared) Then the anesthetist magician came and I fell asleep sweetly. I woke up already in bed, nothing hurt, there were no side effects, just a normal morning awakening. I would never have believed that this was even possible, I am very grateful for a wonderful dream. Before that, I had more than one general anesthesia in state hospitals, and now I understand for sure that they apparently wanted to kill me there, but it didn’t work out. For the next two hours, until it was impossible to get up, wonderful nurses came to me asking how I felt and if I needed something, they put droppers, and I lay and did not believe that everything terrible was over)) 2 hours after the operation, I was already getting up and drank delicious broth and tea. The rest of the time before sleep, I walked around the ward, I didn’t feel any pain at all, a little weakness and nothing more. The next morning I was fed deliciously and discharged home. After being discharged, Aleksey Alekseevich is constantly in touch, he worries about my well-being more than even my relatives. I needed further treatment, he even helps me with this by calling the best doctors and clinics, supporting me. And now I know for sure that I am in the most reliable hands. Thank you very much again. Prosperity to your clinic and low bow to all your doctors. You are the best!!! nine0003

Lilia

05/15/2021 15:57:57

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m. Sukharevskaya

Doctor

Shklya Alekseyevich

on May 7, 2021, underwent a male gynecological surgery, and would like to express gratitude to the attending physician, to the head of the gynecological department Shklyar Aleksey Alekseevich, - for high professionalism, and exceptionally friendly attitude, understandable recommendations. The doctor communicates very correctly, clearly and with explanations. nine0029 Special thanks to the anesthetist Alexey Valeryevich Fomin for the quality anesthesia (I was more afraid of anesthesia than the operation itself), but everything went well, I was “not present” at the operation, and the condition after anesthesia was normal, as after waking up in the morning, no “side effects” ' did not feel.
After the operation, nothing hurt after half an hour, and after an hour and a half, I went home.
The attitude in the hospital was the most friendly, including from the nurses and the administrator at the reception (unfortunately, I did not ask for names). nine0029 It's been a week since the operation, and only the discharge summary # 140035314 reminds me of it.
I'm very glad that I trusted the experience of the Polyclinic.

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