When do signs of an ectopic pregnancy start

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 | Cedars-Sinai

ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

What is an ectopic pregnancy?

A pregnancy that develops outside the uterus is called an ectopic pregnancy. It almost always happens in a fallopian tube. Because of this, it’s often called a tubal pregnancy. In rare cases, an ectopic pregnancy will happen in an ovary, in the cervix, or the belly (abdomen).

What causes an ectopic pregnancy?

A fertilized egg normally moves down a fallopian tube and into the uterus. But the egg can get stuck in the tube if the tube is blocked. This might be from an infection or scar tissue. If the fertilized egg can't reach the uterus, it begins to develop in the tube.

Who is at risk for an ectopic pregnancy?

Ectopic pregnancy is more common in women who:

Have had trouble getting pregnant (infertility)
Have endometriosis. This is when uterine tissue grows in other areas of the pelvis.
Have a sexually transmitted disease. This can cause infection and scarring in the pelvis.
Had tubal surgery
Use an IUD
Had an ectopic pregnancy in the past
Have multiple sex partners
Smoke
Are older

What are the symptoms of an ectopic pregnancy?

Women with an ectopic pregnancy may have irregular bleeding and pelvic or belly (abdominal) pain. The pain is often just on 1 side. Symptoms often happen 6 to 8 weeks after the last normal menstrual period. If the ectopic pregnancy is not in the fallopian tube, symptoms may happen later. The classic symptoms of an ectopic pregnancy are:

Belly (abdominal) pain
No recent period
Vaginal bleeding not related to a period

How is an ectopic pregnancy diagnosed?

Your healthcare provider will measure the level of the hormone hCG (human chorionic gonadotropin) in your blood. They will use ultrasound to check the uterus for a fetus or other pregnancy tissue. In some cases, your healthcare provider will use laparoscopy to diagnose and treat an ectopic pregnancy. This is surgery that uses a lighted tube inserted into your abdomen to check inside the pelvis. It often gives the most accurate diagnosis.

How is an ectopic pregnancy treated?

Ectopic pregnancy may be treated in several ways. This depends on whether the fallopian tube has broken open (ruptured), how far along the pregnancy is, and your hormone levels. Treatments may include:

Letting the ectopic pregnancy heal and the body absorb it on its own. This is only for certain cases.
Using the medicine methotrexate to stop the pregnancy from growing further
Using surgery (usually laparoscopy) to make a small opening in the fallopian tube. The surgeon removes the pregnancy and sometimes the tube.

In rare cases, healthcare providers must make a larger incision in the abdomen to remove the ectopic pregnancy or damaged fallopian tube.

What are possible complications of an ectopic pregnancy?

When the embryo implants in the fallopian tube, it does not have enough room to grow or enough blood flow to keep it healthy, so it dies.

The tube may start to let out some of the tissues or bleed. Some embryos do keep growing and may become large enough to burst the fallopian tube. This can cause severe bleeding and shock.

Ectopic pregnancy is the leading cause of pregnancy-related deaths during the first 3 months of pregnancy in the U.S.

When should I call the healthcare provider?

Don’t ignore symptoms of ectopic pregnancy. Call your healthcare provider if you have any bleeding or pain in pregnancy.

Key points about ectopic pregnancy

Pregnancy that develops outside the uterus is called ectopic pregnancy.
Women with an ectopic pregnancy may have irregular bleeding and pelvic or abdominal pain, often on one side.
Symptoms most often appear 6 to 8 weeks after the last normal menstrual period.
Ectopic pregnancy may be treated in several ways, depending on whether the fallopian tube has burst.
Don’t ignore symptoms of ectopic pregnancy. Call your healthcare provider if you have any bleeding or pain in pregnancy.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.

Medical Reviewer: Irina Burd MD PhD

Medical Reviewer: Donna Freeborn PhD CNM FNP

Medical Reviewer: Heather M Trevino BSN RNC

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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How an ectopic pregnancy manifests itself: the first signs

Given all of the above, it is very important to know how an ectopic pregnancy manifests itself. Timely diagnosis of this pathology will help to avoid complications, and in some cases even save the life of a woman.

In the early stages, women can often ignore unusual symptoms and believe that this is how a normal pregnancy should proceed.

Indeed, as the ovum develops, even with an ectopic pregnancy, a woman may experience signs of a normal pregnancy, namely:

Absence of menses
Increase in basal body temperature
Breast engorgement
Nausea, vomiting

However, along with these symptoms, the first signs of an ectopic pregnancy appear, which should alert. So how does an ectopic pregnancy manifest itself?

The following symptoms may indicate an atypical pregnancy:

Unpleasant sensations in the lower abdomen, aching, pulling pains in the location of the fetal egg, or in the lower abdomen, mainly on one side - the very first signs of an ectopic pregnancy. Pain may increase during urination or defecation.
Scanty bloody, spotting discharge that usually lasts a long time. In rare cases, uterine bleeding, or profuse spotting, resembling menstruation, is observed.
With severe blood loss in the early stages, signs of shock may occur, namely, pale skin, tachycardia, drop in blood pressure, loss of consciousness.

How long can an ectopic pregnancy appear

The timing when the first signs of an ectopic pregnancy appear is individual in each case. In some women, an ectopic pregnancy can be asymptomatic right up to the development of complications, while in others, adverse symptoms can be noticed already from the first weeks of pregnancy.

Usually, the first signs appear with an increase in the size of the fetal egg. Therefore, at what time an ectopic pregnancy appears can be established using ultrasound. Usually, a fetal egg is visualized at a period of 4.5-5 weeks of pregnancy.

The average time for an ectopic pregnancy to appear is 3 to 8 weeks. It is during this period that the highest risk of adverse symptoms!

What are the signs of an ectopic pregnancy at a later date

If you ignore the first signs of an ectopic pregnancy, the risk of complications increases significantly. An ectopic pregnancy can have two outcomes - abortion, or rupture of the fallopian tube, or another organ in which the fetal egg has attached.

In the first case, with an ectopic pregnancy, the signs include intense pain, pain in the posterior vaginal fornix, and bleeding. With intense bleeding, symptoms of shock may appear - a decrease in blood pressure, tachycardia, a weak rapid pulse, shallow breathing, weakness, loss of consciousness.

Signs in case of rupture of the fallopian tube resemble those of ovarian apoplexy. Life-threatening internal bleeding develops, acute, dagger pain in the lower abdomen occurs, which can radiate to the perineum and anus, symptoms of shock are expressed. This condition requires immediate hospitalization!

Signs of ectopic pregnancy on ultrasound

With such a pathology as an ectopic pregnancy, ultrasound signs can be determined at about 4.5-5 weeks of pregnancy. Usually, ultrasound does not allow to detect a fetal egg outside the uterus, so they are guided by other signs.