Ectopic pregnancy: symptoms, treatment and when to get urgent help

An ectopic pregnancy does not always cause symptoms and may only be found on a routine early scan. When symptoms do occur, the NHS says they usually develop between the 4th and 12th weeks of pregnancy, and you may have a missed period, a positive pregnancy test and other signs of pregnancy alongside them.

It is the combination of symptoms that matters. Each can have other causes, such as a stomach bug, which is why the NHS advises getting checked rather than trying to work out the cause yourself.

• Vaginal bleeding that is different from a normal period: the NHS says it often starts and stops, and may be watery and dark brown. Some women mistake it for a period.

• Tummy pain, typically low down on one side, which can come on suddenly or gradually and may be constant or come and go.

• Shoulder tip pain, felt where the shoulder ends and the arm begins. The NHS says it can be a sign of an ectopic pregnancy causing some internal bleeding, so get advice right away.

• Discomfort when going to the toilet, including pain or pressure in your bottom when pooing, pain when peeing or diarrhoea.

Contact your GP or call NHS 111 if you have a combination of these symptoms and think you might be pregnant, even without a positive pregnancy test. The NHS says an ectopic pregnancy can be serious, so it is important to get advice right away.

Call 999 for an ambulance or go to your nearest A&E immediately if you have a combination of the following, because they may mean a fallopian tube has split open (ruptured).

• A sharp, sudden and intense pain in your tummy.

• Feeling very dizzy or fainting.

• Feeling sick.

• Looking very pale.

• The NHS says a rupture can be life threatening but is uncommon and treatable if dealt with quickly, and that deaths from ruptures are extremely rare in the UK.

In a typical pregnancy the fertilised egg travels along a fallopian tube and settles in the lining of the womb. In an ectopic pregnancy it implants somewhere else, most often in one of the tubes that connect the ovaries to the womb. An egg that stays in the tube will not develop into a baby.

The Ectopic Pregnancy Trust adds that a tubal pregnancy is the most common site, but other sites include the ovary, cervix, abdomen or a caesarean scar, and that it is not possible to move an ectopic pregnancy into the womb.

The NHS says around 1 in every 90 pregnancies in the UK is ectopic. The charity says anyone who is sexually active or having fertility treatment is at risk, although there are situations that raise the risk.

The NHS says it can be difficult to diagnose from symptoms alone because they resemble other conditions. A GP may examine you and offer a pregnancy test. If you have symptoms and a positive test, you may be referred to an early pregnancy assessment service.

• Transvaginal ultrasound scan: a small probe is placed in the vagina to give a close-up image. The NHS says it often shows whether a fertilised egg has implanted in a tube, although it can occasionally be difficult to spot.

• Blood tests: the pregnancy hormone hCG may be measured twice, 48 hours apart. The NHS says levels tend to be lower and rise more slowly than in a normal pregnancy, and the result also helps decide on treatment.

• Keyhole surgery (laparoscopy): used under general anaesthetic if it is still unclear or the location of the pregnancy is unknown. If an ectopic pregnancy is found, instruments may be used to remove it during the same procedure.

The NHS says the pregnancy cannot be saved and treatment is usually needed to remove it before it grows too large. There are three main options. Your doctor will discuss the advantages and disadvantages and recommend one based on factors such as your symptoms, the size of the pregnancy and your hCG level.

In most cases keyhole surgery removes the entire tube holding the pregnancy if the other tube looks healthy. The NHS says removing the affected tube is the most effective treatment and is not thought to reduce your chances of becoming pregnant again. You will be asked to consent to this beforehand. If your other tube is not healthy, removing the pregnancy without the whole tube may be attempted.

After surgery, if your blood type is RhD negative, you will be given an injection of anti-D rhesus prophylaxis to help prevent rhesus disease in future pregnancies. The NHS also says anti-D may be offered with medical or surgical treatment if you were at least 12 weeks pregnant at diagnosis and are RhD negative.

In many cases the NHS says it is not clear why a woman has an ectopic pregnancy. Sometimes there is a problem with the fallopian tubes, such as being narrow or blocked. Several factors are associated with a higher risk.

• Pelvic inflammatory disease, usually caused by a sexually transmitted infection.

• A previous ectopic pregnancy: the NHS says the risk of another is around 10%.

• Previous surgery on the fallopian tubes, such as an unsuccessful sterilisation.

• Fertility treatment such as IVF, including medicine to stimulate ovulation.

• Becoming pregnant with an IUD or IUS in place, which is rare but more likely to be ectopic if it happens.

• Smoking.

• Age: the risk is highest for pregnant women aged over 35.

• The NHS says you cannot always prevent an ectopic pregnancy, but using a condom with new partners to protect against STIs and stopping smoking can reduce your risk.

The NHS says losing a pregnancy can be devastating and that many women feel the same grief as if they had lost a family member. It is not uncommon for those feelings to last several months, though they usually improve with time. Speak to your GP if you or your partner are struggling, and consider support groups such as The Ectopic Pregnancy Trust, Ectopic Pregnancy Foundation, Miscarriage UK or Cruse Bereavement Care.

When you feel ready, you will probably be advised to wait until you have had at least 2 periods after treatment before trying again. If you were treated with methotrexate, the NHS says it is usually recommended to wait at least 3 months because the medicine could harm a baby.

If you do become pregnant again, the NHS suggests telling your GP as soon as possible so early scans can check everything is OK. Occasionally, fertility treatment such as IVF is needed.

Ectopic pregnancy is an emergency condition, and NHS routes are the usual first step: your GP, NHS 111, an early pregnancy assessment service, or A&E if symptoms are severe. Early pregnancy units assess patients with scans and hCG blood tests.

Some people also have access to private early pregnancy scans. A private scan can be reassuring, but it does not replace urgent NHS assessment if you have pain, bleeding or feel unwell, and the same urgent advice applies. Treatment of a confirmed ectopic pregnancy is normally arranged through NHS services.