Ectopic pregnancy explained: a life-threatening emergency

What an ectopic pregnancy is

In a normal pregnancy, a fertilised egg travels down the fallopian tube and settles in the lining of the womb, where there is room to grow. In an ectopic pregnancy, the egg implants somewhere else, most commonly in a fallopian tube, which is why it is sometimes called a tubal pregnancy. Rarely it can be elsewhere, such as an ovary or the scar of a previous caesarean. A fallopian tube is narrow and cannot stretch to accommodate a growing pregnancy, so the pregnancy cannot develop safely and, sadly, cannot be moved to the womb. If it continues to grow, it can split the tube open, causing dangerous internal bleeding. This is why an ectopic pregnancy always needs prompt medical attention.

Warning signs to watch for

An ectopic pregnancy usually shows itself between around weeks four and twelve, sometimes before a woman even knows she is pregnant. Common early signs include pain low down on one side of the tummy, unusual vaginal bleeding that may be different from a normal period — often darker and more watery — and a missed period with other pregnancy signs. Some women feel discomfort when passing urine or opening their bowels. A very important and easily missed sign is pain felt at the tip of the shoulder, which can happen when internal bleeding irritates nerves under the diaphragm. Any woman who could be pregnant and has these symptoms should seek medical assessment urgently, as early diagnosis makes treatment safer.

When it is an emergency: call 999

An ectopic pregnancy can rupture, causing heavy internal bleeding that is life-threatening. Signs of this emergency include sudden, severe tummy pain, feeling very dizzy, faint or actually collapsing, looking very pale, a racing heart, and shoulder-tip pain. If a woman who could be pregnant develops these signs, this is a medical emergency — call 999 or go straight to A&E. Do not wait to see if it passes, and do not drive yourself. Internal bleeding may not be visible from outside, so someone can be seriously unwell without obvious blood loss. Acting immediately can be life-saving, which is why these particular symptoms should never be ignored or delayed.

How it is diagnosed

When an ectopic pregnancy is suspected, assessment usually takes place in an early pregnancy unit or A&E. A urine or blood test confirms pregnancy, and a blood test measuring the pregnancy hormone can be repeated over a couple of days, because in an ectopic pregnancy the level often rises more slowly than expected. The main test is an ultrasound scan, usually done internally through the vagina, which can show whether the pregnancy is in the womb and may reveal it in the tube. Sometimes the location is not clear at first and monitoring is needed. If a woman is seriously unwell with signs of rupture, doctors may proceed straight to surgery rather than waiting for tests.

Treatment and looking ahead

Treatment depends on how far the pregnancy has developed, symptoms, hormone levels and the woman's wishes. Where an early ectopic is causing few symptoms, careful monitoring may be possible as some resolve on their own. A medicine can be used to stop the pregnancy developing so the body reabsorbs it, avoiding surgery. If the tube has ruptured or there are worrying signs, surgery is needed, often keyhole surgery to remove the affected tube or, where possible, just the pregnancy. Losing a pregnancy this way can be physically and emotionally hard, and support is available. Most women who have had one ectopic pregnancy can go on to have a healthy pregnancy in future, though the risk of another is somewhat higher.