The most common cause of ectopic pregnancy:

In a normal pregnancy, the fertilized egg implants and develops in the uterus. In an ectopic pregnancy, the egg implants somewhere other than the uterus — often, in the fallopian tubes. This is why ectopic pregnancies are commonly called "tubal pregnancies." The egg also can implant in the ovary, abdomen, or the cervix.

None of these areas has the right space or nurturing tissue for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth.

Ectopic pregnancy can be hard to diagnose because symptoms often are like those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, tiredness, or frequent urination (peeing).

Often, the first warning signs of an ectopic pregnancy are pain or vaginal bleeding. There might be pain in the pelvis, abdomen, or even the shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). The pain can range from mild and dull to severe and sharp. It might be felt on just one side of the pelvis or all over.

These symptoms also might happen with an ectopic pregnancy:

• vaginal spotting
• dizziness or fainting (caused by blood loss)
• low blood pressure (also caused by blood loss)
• lower back pain

What Causes an Ectopic Pregnancy?

An ectopic pregnancy usually happens because a fertilized egg couldn’t quickly move down the fallopian tube into the uterus. The tube can get blocked from an infection or inflammation. The tube can get blocked from:

• pelvic inflammatory disease (PID)
• endometriosis, when cells from the lining of the uterus implant and grow elsewhere in the body
• scar tissue from previous abdominal or fallopian surgeries
• rarely, birth defects that changed the shape of the tube

How Is an Ectopic Pregnancy Diagnosed?

If a woman might have an ectopic pregnancy, her doctor may do an ultrasound to see where the developing fetus is. Often, pregnancies are too small to see on ultrasound until more than 5 or 6 weeks after a woman’s last menstrual period. If an external ultrasound can’t show the pregnancy, the doctor might do the test with a wand-like device in the vagina.

A woman might need testing every few days if the first tests can’t confirm or rule out an ectopic pregnancy.

How Is an Ectopic Pregnancy Treated?

How doctors treat an ectopic pregnancy depends on things like the size and location of the pregnancy.

Sometimes they can treat an early ectopic pregnancy with an injection of methotrexate, which stops the growth of the embryo. The tissue usually is then absorbed by the woman’s body.

If the pregnancy is farther along, doctors usually need to do surgery to remove the abnormal pregnancy.

Whatever treatment she gets, a woman will see her doctor regularly afterward to make sure her pregnancy hormone levels return to zero. This may take several weeks. An elevated level could mean that some ectopic tissue was missed. If so, she might need more methotrexate or surgery.

What About Future Pregnancies?

Most women who have had an ectopic pregnancy can have normal pregnancies in the future. Having had one ectopic pregnancy does increase a woman’s risk of having another one.

What Else Should I Know?

Any woman can have an ectopic pregnancy. But the risk is higher for women who are older than 35 and those who have had:

• PID
• a previous ectopic pregnancy
• surgery on a fallopian tube
• infertility problems or medicine to stimulate ovulation

Some birth control methods also can affect a woman's risk of ectopic pregnancy. Those who become pregnant while using an intrauterine device (IUD) might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also increase the risk of an ectopic pregnancy.

When Should I Call the Doctor?

If you believe you're at risk for an ectopic pregnancy, meet with your doctor to talk about your options before you become pregnant. If you are pregnant and have any concerns about the pregnancy being ectopic, talk to your doctor — it's important to find it early. Your doctor might want to check your hormone levels or schedule an early ultrasound to ensure that your pregnancy is developing normally.

Call your doctor right away if you're pregnant and having any pain, bleeding, or other symptoms of ectopic pregnancy.

Assisted Reproductive Technology: A group of infertility treatments in which an egg is fertilized with a sperm outside the body; the fertilized egg then is transferred to the uterus.

Endometriosis: A condition in which tissue that lines the uterus is found outside of the uterus, usually on the ovaries, fallopian tubes, and other pelvic structures.

Fallopian Tube: Tube through which an egg travels from the ovary to the uterus.

General Anesthesia: The use of drugs that produce a sleep-like state to prevent pain during surgery.

Hormone: A substance made in the body by cells or organs that controls the function of cells or organs.

In Vitro Fertilization (IVF): A procedure in which an egg is removed from a woman’s ovary, fertilized in a laboratory with the man’s sperm, and then transferred to the woman’s uterus to achieve a pregnancy.

Laparoscopy: A surgical procedure in which an instrument called a laparoscope is inserted into the pelvic cavity through a small incision. The laparoscope is used to view the pelvic organs. Other instruments can be used with it to perform surgery.

Obstetrician–Gynecologist (Ob-Gyn): A physician with special skills, training, and education in women’s health.

Pelvic Inflammatory Disease: An infection of the uterus, fallopian tubes, and nearby pelvic structures.

Sexually Transmitted Infections (STIs): Infections that are spread by sexual contact, including chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).

Ultrasound Exam: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

What is Ectopic Pregnancy?

An ectopic pregnancy is a pregnancy that happens outside of the uterus. This happens when a fertilized egg implants in a structure that can’t support its growth. An ectopic pregnancy often happens in the fallopian tube (a pair of structures that connect the ovaries and uterus). In rare cases, an ectopic pregnancy can occur on an ovary or in the abdominal cavity.

This is a life-threatening condition. An ectopic pregnancy is not a pregnancy that can be carried to term (till birth) and can be dangerous for the mother if not treated right away.

Where does an ectopic pregnancy happen?

It’s considered an ectopic pregnancy whenever the fertilized egg implants outside of your uterus. The egg is meant to travel down the fallopian tubes and imbed itself into the wall of your uterus, where it can begin to develop. In an ectopic pregnancy, the egg implants in one of the structures along the way. The most common place this can happen is within the fallopian tubes. The majority of ectopic pregnancies happen here—called a tubal ectopic pregnancy. A fertilized egg can also implant on other organs in your abdominal cavity. This is a rarer form of ectopic pregnancy than one that happens in a fallopian tube.

How serious is an ectopic pregnancy?

An ectopic pregnancy is a medical emergency. The uterus is uniquely suited to hold a growing fetus. It’s an organ that can stretch and expand as the fetus grows. Your fallopian tubes aren’t as flexible. They can burst as the fertilized egg develops. When this happens, you can experience large amounts of internal bleeding. This is life threatening. An ectopic pregnancy needs to be treated right away to avoid injury to the fallopian tube, other organs in the abdominal cavity, internal bleeding and death.

Can my pregnancy continue after an ectopic pregnancy?

Unfortunately, an ectopic pregnancy is fatal for the fetus. It cannot survive outside of the uterus. Quick treatment for an ectopic pregnancy is important to protect the mother’s life. If the egg has implanted in the fallopian tube and the tube bursts, there can be severe internal bleeding. This can lead to maternal death.

In most cases, an ectopic pregnancy is caused by conditions that slow down or block the movement of the egg down the fallopian tube and into the uterus.

How do I know if I’m at risk of an ectopic pregnancy?

There are several risk factors that could increase your chance of developing an ectopic pregnancy. A risk factor is a trait or behavior that increases your chance for developing a disease or condition. You may be at a higher risk of developing an ectopic pregnancy if you’ve had:

• A previous ectopic pregnancy.
• A history of pelvic inflammatory disease (PID), an infection that can cause scar tissue to form in your fallopian tubes, uterus, ovaries and cervix.
• Surgery on your fallopian tubes (including tubal ligation, also referred to as having your tubes tied) or on the other organs of your pelvic area.
• A history of infertility.
• Treatment for infertility with in vitro fertilization (IVF).
• Endometriosis.
• Sexually transmitted infections (STIs).
• An intrauterine device (IUD), a form of birth control, in place at the time of conception.
• A history of smoking.

Your risk can also increase as you get older. Women over age 35 are more at risk than younger women.

Many women who experience an ectopic pregnancy don’t have any of the above risk factors.

What are the symptoms of an ectopic pregnancy?

The early symptoms of an ectopic pregnancy can be very similar to typical pregnancy symptoms. However, you may experience additional symptoms during an ectopic pregnancy, including:

• Vaginal bleeding.
• Pain in your lower abdomen, pelvis and lower back.
• Dizziness or weakness.

If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause additional symptoms. These can include:

• Fainting.
• Low blood pressure (hypotension).
• Shoulder pain.
• Rectal pressure.

When a tube bursts, you may feel sharp lower abdominal pain. This is a medical emergency and you will need to contact your healthcare provider or go to the emergency room immediately.

If you realize that you are pregnant and have an IUD (intrauterine device for contraception) in place, or have a history of a tubal ligation (having your tubes tied by surgery or at the time of a C-section), contact your healthcare provider right away. Ectopic pregnancy is more common in these situations.

An ectopic pregnancy is typically diagnosed during an appointment in your healthcare provider’s office. Your provider will perform several tests to first confirm a pregnancy, and then look for the ectopic pregnancy. These tests include:

• A urine test: This test involves either urinating on a test strip (typically shaped like a stick) or urinating into a cup in your provider’s office and then having a test strip dipped into the urine sample.
• A blood test: You provider may test your blood to see how much of the hormone human chorionic gonadotropin (hCG) you have in your body. This hormone is produced during pregnancy. You may also hear this called your serum beta-hCG level.
• An ultrasound exam: An imaging test, an ultrasound uses sound waves to create a picture of your body’s internal structures. Ultrasound is often used during pregnancy. Your provider will use this test to see where the fertilized egg has implanted.

Once your provider has confirmed the pregnancy and determined where the fertilized egg has implanted, a treatment plan will be created. Ectopic pregnancy is an emergency and treatment for this condition is very important.

If your fallopian tube ruptures, you will need to go to the emergency room and be treated immediately. In those cases, there’s no time to wait for an appointment.

How early in a pregnancy is an ectopic pregnancy detected?

Ectopic pregnancy is typically discovered very early in pregnancy. Most cases are found within the first trimester (the first three months). It usually is discovered by the eighth week of pregnancy.

There are several ways that an ectopic pregnancy can be treated. In some cases, your provider may suggest using a medication called methotrexate to stop the growth of the pregnancy. This will end your pregnancy. Methotrexate is given in an injection by your healthcare provider. This option is less invasive than surgery, but it does require follow-up appointments with your provider where you hCG levels will be monitored.

In severe cases, surgery is often used. Your provider will want to operate when your fallopian tube has ruptured or if you are at a risk of rupture. This is an emergency surgery and a life-saving treatment. The procedure is typically done laparoscopically (through several small incisions instead of one bigger cut). The surgeon may remove the entire fallopian tube with the egg still inside it or remove the egg from the tube if possible.

An ectopic pregnancy cannot be prevented. But you can try to reduce your risk factors by following good lifestyle habits. These can include not smoking, maintaining a healthy weight and diet, and preventing any sexually transmitted infections (STIs). Talk to your healthcare provider about any risk factors you may have before trying to become pregnant.

Most women who have had an ectopic pregnancy can go on to have future successful pregnancies. There is a higher risk of having future ectopic pregnancies after you have had one. It’s important to talk to your healthcare provider about the causes of your ectopic pregnancy and what risk factors you may have that could cause a future ectopic pregnancy.

How long should I wait before becoming pregnant again after an ectopic pregnancy?

You should talk to your healthcare provider about future pregnancies after being treated for an ectopic pregnancy. Although pregnancy may happen quickly after treatment, it’s often best to wait about three months. This allows your fallopian tube time to heal and decreases the risk of another ectopic pregnancy.

In most cases, you can still have a baby if you have had one of your fallopian tubes removed. You have a pair of fallopian tubes and eggs can still travel down your remaining tube. There are also assisted fertility procedures where the egg is extracted from the ovary, fertilized outside of the body and placed in the uterus for implantation. This is called in vitro fertilization (IVF).

Have an open conversation about your thoughts on future pregnancies with your healthcare provider. Together, you can form a plan and discuss ways to decrease any risk factors you may have.

Last reviewed by a Cleveland Clinic medical professional on 02/06/2020.

References

• The American College of Obstetricians and Gynecologists. Ectopic Pregnancy. (https://www.acog.org/Patients/FAQs/Ectopic-Pregnancy?IsMobileSet=false) Accessed 2/7/2020.
• American Pregnancy Association. Ectopic Pregnancy. (https://americanpregnancy.org/pregnancy-complications/ectopic-pregnancy/) Accessed 2/7/2020.
• Merck Manual Professional Version. Ectopic Pregnancy. (https://www.merckmanuals.com/professional/gynecology-and-obstetrics/abnormalities-of-pregnancy/ectopic-pregnancy) Accessed 2/7/2020.
• Tenore J. Ectopic Pregnancy. (https://www.aafp.org/afp/2000/0215/p1080.html) American Family Physician. Feb 2000. 15;61(4): 1080-1088. Accessed 2/7/2020.
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