Pregnant in my fallopian tubes

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 (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.

Can a baby survive an ectopic pregnancy?

No. 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.

Signs and Symptoms of Ectopic Pregnancy

At first you may not have any symptoms of an early ectopic pregnancy. They may seem very similar to those of a normal pregnancy. You might miss your period and have discomfort in your belly and tenderness in your breasts.

Only about half of women with an ectopic pregnancy will have all three of the main signs: a missed period, vaginal bleeding, and belly pain.

Early signs of an ectopic pregnancy include:

• Upset stomach and vomiting
• Sharp belly 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.

When Do Ectopic Pregnancies Start?

Symptoms of an ectopic pregnancy usually develop fairly early in the pregnancy: between the 4th and 12th weeks.

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:

• 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
• 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. A ruptured ectopic pregnancy 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 increase. 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.

An ultrasound for ectopic pregnancy is a noninvasive test that uses sound waves to create images of the inside of the uterus. The test is performed by a sonographer and may be done transvaginally or transabdominally. During the ultrasound, the doctor will look for the presence of a gestational sac, the location of the gestational sac, and whether there is a fetal heartbeat. The test is painless and usually takes around 15 to 20 minutes.

An abdominal ultrasound test, which is performed by moving a wand over the abdomen, may be used to confirm pregnancy or check for internal bleeding.

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 levels of hCG (human chorionic gonadotropin). It’s the hormone your body makes 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
• 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.

How to Avoid an Ectopic Pregnancy

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 pelvic inflammatory disease and sexually transmitted infections.
• Avoid using a vaginal douche. Studies show that using a douche can increase the risk of ectopic pregnancy.

Next In Ectopic Pregnancy Series:

Removal of fallopian tubes - methods of operation and consequences

A woman's fallopian tubes are removed only as a last resort. The operation is not planned in advance, so a woman cannot have time to prepare for such a disaster and give birth to a child. What to do now? Is there any chance of getting pregnant?

About fallopian tubes

Everyone knows that the fallopian tubes are needed for pregnancy. But for what exactly? In fact, these organs are just "conductors" for the egg (oocyte).

The egg is formed in the ovaries, bean-shaped organs that are located on the sides of the uterus and above it, but are not connected with it in any way. During ovulation, the oocyte enters the pelvic cavity and, theoretically, can settle anywhere: on the intestines, on top of the uterus, on the fallopian tubes and on the ovary itself. But fertilization must take place inside the uterus.

In order for the egg to reach the uterine cavity, the fallopian tubes are needed. At their end there are "cilia". They, contracting, create such a wave in the pelvic cavity, which "drives" the oocyte inside the fallopian tubes and conducts them to the uterus. But if there are no fallopian tubes, there is no one to “catch” and “see off” the egg every month.

There is a way out!

Unfortunately, organs such as the fallopian tubes have not yet learned how to make artificially. Although attempts have been made. Theoretically, it is possible to make tubes of this diameter from a person’s own intestines, and you can even sew them to the uterus, but they will not be able to contract - the egg will stop in them and collapse after a while. But do not rush to get upset!

If only the fallopian tubes are removed, and at least one ovary remains, you can get pregnant using in vitro fertilization (IVF). It involves the isolation of an egg separately, a separate spermatozoa, with their subsequent connection in a test tube. When doctors are convinced that such a fusion resulted in an embryo (usually there are several of them at once, since several eggs are taken), it is introduced into the uterine cavity and all conditions are created so that it is fixed there. Throughout the pregnancy, a woman will be helped to maintain such a hormonal background in order to eliminate the risk of miscarriage or premature birth.

And if the fallopian tubes are removed with the ovaries?

This is a very sad situation in which a woman's eggs are not synthesized at all. However, there is a way out of it. This is IVF with donor oocytes.

The essence of the procedure is as follows. There are women who want to earn money by donating their own eggs. They are examined, healthy and ready for hormonal stimulation, which will lead to the maturation of their own oocytes. If you conclude an agreement with such a woman, after a time when her eggs mature, you and your husband will be called to the clinic. Doctors will need to fertilize her cells in a test tube with your spouse's seminal fluid.

From this moment on, you will need to take hormonal drugs already - in order to prepare the body for a future pregnancy. If the embryos are developing normally, after about 5 days they will come back to the clinic: the prepared embryos (they will be pre-examined for genetic diseases) will be introduced into your uterus. The procedure takes about 10 minutes, after which you need to lie down for another 2-3 hours - and you can return home.

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