Outside uterus pregnancy symptoms

Ectopic (Extrauterine) Pregnancy

Series Ectopic Pregnancy

Written by Shishira Sreenivas

What Is Ectopic Pregnancy?

Usually, a fertilized egg attaches itself to the lining in your uterus. But with an ectopic pregnancy (also called extrauterine pregnancy), the fertilized egg grows outside your uterus. This can include other areas like a fallopian tube, the ovaries, in your belly, or the lower part of your cervix, which is above the vagina. In more than 90% of cases, the egg attaches itself in a fallopian tube. This is called a tubal pregnancy.

Rates are hard to determine, but one study suggests that about 1 in 50 pregnancies in the U.S. are ectopic. As the fertilized egg grows, it can burst (rupture) and can cause life-threatening bleeding. If this happens, you will need medical care right away. If you don’t treat it, it can be deadly. In fact, ectopic pregnancies are the leading cause of pregnancy-related deaths in the first trimester.

It’s important to note that the fertilized egg in an ectopic pregnancy is not “viable. ” That means it’s impossible for the egg to survive and grow into a baby that can survive in or outside your body. It will always result in a pregnancy loss. That’s because the egg can’t get the blood supply and support it needs to grow outside of the uterus.

Ectopic Pregnancy Signs and Symptoms

Most of the time, an ectopic pregnancy happens within the first few weeks of pregnancy. You might not even know that you're pregnant and may not notice any problems.

Early signs of an ectopic pregnancy include:

Light vaginal bleeding and pelvic pain
Upset stomach and vomiting
Sharp abdominal cramps
Pain on one side of your body
Dizziness or weakness
Pain in your shoulder, neck, or rectum

An ectopic pregnancy can cause your fallopian tube to burst or rupture. Emergency symptoms include major pain, with or without severe bleeding. Call your doctor right away if you have heavy vaginal bleeding with lightheadedness, fainting, or shoulder pain, or if you have severe belly pain, especially on one side.

You might need to call 911 or head to the nearest hospital to have it treated right away.

Ectopic Pregnancy Causes and Risk Factors

You may never know why you have an ectopic pregnancy. One cause could be a damaged fallopian tube. It could keep the fertilized egg from getting into your uterus.

You’re more likely to have an ectopic pregnancy if you:

Have pelvic inflammatory disease (PID)
Smoke cigarettes
Are older than 35
Have a sexually transmitted infection
Have scarring from pelvic surgery
Had a previous ectopic pregnancy
Tried to have tubal ligation (tubes tied) or tubal ligation reversal
Use fertility drugs
Had fertility treatments such as in vitro fertilization (IVF)

It could also happen if you become pregnant while you have an intrauterine device (IUD) for birth control.

Ectopic Pregnancy Complications

During an ectopic pregnancy, the fertilized egg is wrapped in a structure that can grow for several weeks outside your uterus. But the structure usually bursts between 6 and 16 weeks. This can cause severe bleeding. If the bleeding isn’t stopped, your body might start to shut down due to the blood loss (hemorrhagic shock), and the odds of dying from it increases. If it’s treated before it bursts, it rarely results in death.

If the structure does burst, it may damage the fallopian tube it was attached to. Your doctor might remove the fallopian tube during the surgery. But you have two fallopian tubes. If your other fallopian tube is healthy, you should still be able to get pregnant. But if your other fallopian tube is damaged or not there, you may have fertility issues. In this case, talk to your doctor about other ways to get pregnant, like IVF (in vitro fertilization).

Ectopic Pregnancy Diagnosis

Your doctor will probably do tests that include a pregnancy test and a pelvic exam. They might give you an ultrasound to look at your uterus and fallopian tubes.

Ectopic Pregnancy Treatment

Because a fertilized egg can’t survive outside a uterus, your doctor will need to take it out, so you don’t have serious health problems. They’ll use one of two methods: medication or surgery.

Medication. If your fallopian tube hasn’t ruptured and your pregnancy isn’t far along, your doctor can give you a shot of methotrexate (Trexall). You only need one dose of the injection. It stops the fertilized egg from growing. Your body will absorb the egg in about 4-6 weeks. With this treatment, there’s no need to remove the fallopian tube.

Before you can take methotrexate, your doctor will need to run a few blood tests to measure your hCG levels (human chorionic gonadotropin). It’s the hormone your body produces when it detects a pregnancy. You won’t be able to take methotrexate if you’re breastfeeding or have certain health problems.

Once you get the shot, the doctor will check your hCG levels during follow-up appointments. If your levels don’t drop after the first dose, you might need a second dose of the same medication. You’ll need to follow up until your blood no longer has hCG.

It’s important to note that taking methotrexate is not the same as having a medical abortion, as you could get if you had a “viable” pregnancy in which the fertilized egg attaches inside the uterus. For a medical abortion, you need a combination of two prescription drugs: mifepristone and misoprostol.

The methotrexate that you take during an ectopic pregnancy before the egg bursts is medically necessary. It can lower your risk of dying or other serious complications.

Surgery. In other cases, you’ll need surgery. The most common is laparoscopy. Your doctor will make very small cuts in your lower belly and insert a thin, flexible tube called a laparoscope to remove the ectopic pregnancy. If your fallopian tube is damaged, they may have to remove it as well. If you’re bleeding a lot or your doctor suspects that your fallopian tube is ruptured, you might need emergency surgery with a larger cut. This is called a laparotomy.

Surgery side effects can include:

Pain
Fatigue
Bleeding
Infection

Whether you take methotrexate or have surgery, you may feel tired for a few weeks and have some discomfort in your belly. You may continue to have pregnancy-like symptoms for a bit. It might take a few period cycles before you feel back to normal.

After an Ectopic Pregnancy

It might be hard for you to have a typical pregnancy afterward. Consider talking to a fertility specialist, especially if you had a fallopian tube removed.

And talk to your doctor about how long to wait before trying again. Some experts suggest giving yourself at least 3 months so your body has time to heal.

An ectopic pregnancy raises your risk of having another one. If you think you’re having another pregnancy, be mindful of the changes in your body. Check with your doctor, and they can confirm it and take the necessary steps.

An ectopic pregnancy can take a toll on your mental health, too. Don’t hesitate to reach out to mental health experts like a licensed counselor or therapist.

There’s no way to prevent an ectopic pregnancy. But you can lower your odds with certain lifestyle choices.

You can:

Use a condom when you have sex. This can lower your risk for PID and other sexually transmitted infections (STIs)
Quit smoking.
Avoid using a vaginal douche. Studies show that using a douche can increase the risk of ectopic pregnancy.

Next In Ectopic Pregnancy Series:

Symptoms

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 - causes and treatment

If the fixation and subsequent development of the ovum occurs outside the uterus, then the pregnancy is called ectopic (ectopic). It occurs in 2% of all pregnancies. The embryo can be fixed on the ovary, in the abdominal cavity, in the cervix, in the fallopian tubes. An ectopic pregnancy in the early stages is no different from a normal one.

An egg is released from the ovary during ovulation and enters the fallopian tube. Fertilization occurs when a sperm and an egg meet in the ampulla of the fallopian tube. Normally, at the end of the first week after fertilization, the embryo enters the uterine cavity and implantation occurs. A fertilized egg can develop normally only in the uterus. nine0003

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. nine0003

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

Until the fetal egg overstretches 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; nine0010
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. nine0003

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. nine0003

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; nine0010
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; nine0010
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. nine0010

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;
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; nine0010
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; nine0010
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. nine0003

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. nine0003

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 a fertilized egg that has attached itself 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. nine0003

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 carrying a healthy child are quite high. When planning a pregnancy, be sure to consult a doctor. nine0003

How to avoid ectopic pregnancy

Prevention involves reducing the likelihood of the causes that lead to the development of ectopic pregnancy:

timely treatment of inflammatory diseases of the genital organs;
reliable contraception as abortion prevention;
use of contraceptives strictly under medical supervision;
pregnancy planning, complete examination;

Regular visits to the gynecologist and examination for various infections are also important. If you suspect pregnancy, contact the MEDICA Fetal Medicine Center, experienced specialists will consult, diagnose and determine the type of pregnancy.

If you suspect pregnancy or you are concerned about a delay, then contact the Medica Fetal Medicine Center, experienced specialists will consult, diagnose and determine the type of pregnancy. nine0003

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? nine0250

After fertilization, the egg moves sequentially through the cilia of the epithelium along the fallopian tube 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. nine0003

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; nine0010
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; nine0010
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;
surgery on fallopian tube;
previous ectopic pregnancy.

Risk factors for pathology:

woman's age over 35;
surgery for diseases of the abdominal organs; nine0010
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. nine0003

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. nine0010

Treatment of ectopic pregnancy

The child cannot develop outside the uterus, and the spontaneous interruption of such a pathological process is dangerous for the 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. nine0003

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

Generally, the consequences of an ectopic pregnancy are relatively benign: 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? nine0007

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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