A fertilized egg normally implants in the lining of the uterus. In an ectopic pregnancy, it grows outside the uterus, including in the fallopian tube, ovary, abdomen or lower cervix just above the vagina. In more than 90% of cases, the egg implants in a fallopian tube; this is called a tubal pregnancy.
How common is ectopic pregnancy?
The rate is difficult to determine, but one study suggests that about 1 in 50 pregnancies in the United States is ectopic. As the fertilized egg grows, it may rupture and cause life-threatening bleeding. This requires immediate medical care and can be fatal if untreated. Ectopic pregnancy is a leading cause of pregnancy-related death in the first trimester.
Can a baby survive an ectopic pregnancy?
No. An ectopic pregnancy is not viable: the fertilized egg cannot survive and develop into a baby that can live inside or outside the body. The pregnancy cannot continue because the egg cannot obtain the blood supply and support it needs outside the uterus.
Ectopic pregnancy and miscarriage
A miscarriage is the unexpected loss of a pregnancy before 20 weeks. Although an ectopic pregnancy results in pregnancy loss, miscarriages may also have other causes, such as extra or missing chromosomes.
Symptoms of ectopic pregnancy
At first, you may have no symptoms. Early symptoms can resemble those of a typical pregnancy, including a missed period, abdominal discomfort and breast tenderness.
Only about half of women have all three main signs: a missed period, vaginal bleeding and abdominal pain.
Early signs include:
Upset stomach and vomiting
Severe abdominal cramps
Pain on one side of the body
Dizziness or weakness
Pain in the shoulder, neck or rectum
Signs of a ruptured ectopic pregnancy
An ectopic pregnancy can rupture a fallopian tube. Emergency symptoms include severe pain with or without heavy bleeding. Contact a doctor immediately if you have heavy vaginal bleeding with dizziness, fainting or shoulder pain, or severe abdominal pain, especially on one side.
You may need to call emergency services or go to the nearest hospital for immediate treatment.
When do symptoms begin?
Symptoms usually develop early in pregnancy, between weeks 4 and 12.
Locations of ectopic pregnancy
Although most occur in a fallopian tube, a fertilized egg can implant elsewhere outside the uterus.
Other types include:
Ovarian ectopic pregnancy (OEP)
This occurs when a fertilized egg implants on the outside of an ovary. OEP may be related to a problem with egg release during the menstrual cycle. An egg may be fertilized while still inside the ovarian follicle, or OEP may occur as the egg moves from a fallopian tube toward the ovary.
Abdominal ectopic pregnancy
Rarely, a pregnancy develops in the abdominal cavity between the abdominal wall and spine. Fluid movement in the abdomen may carry an egg behind the uterus, where sperm fertilizes it, or an embryo may travel from the reproductive tract to the abdomen through lymphatic channels.
Cervical ectopic pregnancy
This occurs when an egg implants in the cervical canal, possibly because of damage within the uterine cavity.
Cesarean scar ectopic pregnancy (CSEP)
CSEP occurs when a fertilized egg attaches to scar tissue from a cesarean delivery. Because scar tissue is more fragile than the uterine lining, it may tear and cause heavy bleeding.
Symptoms of these ectopic pregnancies, including vaginal bleeding and lower abdominal pain, resemble those of a tubal pregnancy.
Causes of ectopic pregnancy
The cause may never be known. One possible cause is a damaged fallopian tube that prevents a fertilized egg from reaching the uterus.
Risk factors for ectopic pregnancy
Risk is higher if you:
Smoke
Are over age 35
Have a sexually transmitted infection
Have scarring from pelvic surgery
Have had an ectopic pregnancy
Have undergone tubal ligation or tubal-ligation reversal
Have received fertility treatment such as in vitro fertilization (IVF)
These factors make ectopic pregnancy more likely.
An ectopic pregnancy may also occur if you become pregnant while using an intrauterine device (IUD).
Ectopic pregnancy and endometriosis
Endometriosis is a painful condition in which tissue similar to the uterine lining grows outside the uterus, commonly on the ovaries, fallopian tubes and pelvic lining. Scarring from the condition may prevent a fertilized egg from reaching the uterus and cause an ectopic pregnancy.
Complications
In an ectopic pregnancy, the fertilized egg is enclosed in a structure that can grow outside the uterus for several weeks, but it usually ruptures between 6 and 16 weeks. Rupture can cause severe bleeding. If bleeding is not stopped, excessive blood loss may cause the body to shut down (hemorrhagic shock), increasing the risk of death. Treatment before rupture is rarely fatal.
Rupture may damage the affected fallopian tube, which may need to be removed surgically. Because there are two fallopian tubes, pregnancy may still be possible if the other is healthy. If it is damaged or absent, fertility problems may occur. In that case, discuss other ways to become pregnant, such as IVF, with a doctor.
Diagnosis
A doctor may perform tests including a pregnancy test and pelvic examination, and may use ultrasound to examine the uterus and fallopian tubes.
Ultrasound is a noninvasive test that uses sound waves to create images inside the uterus. A sonographer may perform it through the vagina or abdomen. The clinician looks for a gestational sac, its location and a fetal heartbeat. The test is painless and usually takes about 15 to 20 minutes.
An abdominal ultrasound, performed by moving a probe over the abdomen, may confirm pregnancy or check for internal bleeding.
Treatment
Because a fertilized egg cannot survive outside the uterus, it must be removed to prevent serious health problems. Treatment uses medication or surgery.
Methotrexate treatment
If the fallopian tube has not ruptured and the pregnancy is not advanced, a doctor may give an injection of methotrexate (Trexall). One dose may be sufficient. It stops the fertilized egg from growing, and the body absorbs the tissue over about 4-6 weeks without removing the fallopian tube.
Before methotrexate, blood tests are needed to measure hCG (human chorionic gonadotropin), a hormone produced during pregnancy. Methotrexate cannot be used while breastfeeding or with certain health conditions.
After the injection, hCG levels are checked at follow-up visits. If they do not fall after the first dose, a second dose may be needed. Follow-up continues until hCG is no longer detected in the blood.
Methotrexate treatment differs from medication abortion, which may be used for a viable pregnancy implanted in the uterus. Medication abortion uses two prescription drugs: mifepristone and misoprostol.
Using methotrexate before an ectopic pregnancy ruptures is medically necessary and reduces the risk of death or other serious complications.
Surgical treatment
In other cases, surgery is required. Laparoscopic surgery is most common. The doctor makes very small incisions in the lower abdomen and inserts a thin, flexible tube called a laparoscope to remove the ectopic pregnancy. A damaged fallopian tube may also need to be removed. Heavy bleeding or suspected tubal rupture may require emergency surgery through a larger incision, called laparotomy.
Possible surgical side effects include:
Pain
Bleeding
Infection
After methotrexate or surgery, fatigue and abdominal discomfort may last several weeks, and pregnancy-like symptoms may continue temporarily. Menstrual cycles may take several months to return to normal.
After an ectopic pregnancy
A future intrauterine pregnancy may be more difficult, especially after removal of a fallopian tube. Consider speaking with a fertility specialist.
Ask your doctor how long to wait before trying again. Some experts recommend at least 3 months to allow the body to recover.
A previous ectopic pregnancy increases the risk of another. If you think you are pregnant again, monitor changes in your body and contact a doctor for confirmation and appropriate care.
Ectopic pregnancy can also affect mental health. Do not hesitate to seek support from a mental health professional, such as a licensed counselor or therapist.
How to reduce the risk
Ectopic pregnancy cannot be prevented, but certain lifestyle choices may reduce the risk.
You can:
Use condoms during sex to reduce the risk of pelvic inflammatory disease and sexually transmitted infections.
Avoid vaginal douching. Studies suggest that douching may increase the risk of ectopic pregnancy.
Insights | Ectopic pregnancy: Causes, risks and prevention
A fertilized egg normally implants in the lining of the uterus. In an ectopic pregnancy, it grows outside the uterus, including in the fallopian tube, ovary, abdomen or lower cervix just above the vagina. In more than 90% of cases, the egg implants in a fallopian tube; this is called a tubal pregnancy.
How common is ectopic pregnancy?
The rate is difficult to determine, but one study suggests that about 1 in 50 pregnancies in the United States is ectopic. As the fertilized egg grows, it may rupture and cause life-threatening bleeding. This requires immediate medical care and can be fatal if untreated. Ectopic pregnancy is a leading cause of pregnancy-related death in the first trimester.
Can a baby survive an ectopic pregnancy?
No. An ectopic pregnancy is not viable: the fertilized egg cannot survive and develop into a baby that can live inside or outside the body. The pregnancy cannot continue because the egg cannot obtain the blood supply and support it needs outside the uterus.
Ectopic pregnancy and miscarriage
A miscarriage is the unexpected loss of a pregnancy before 20 weeks. Although an ectopic pregnancy results in pregnancy loss, miscarriages may also have other causes, such as extra or missing chromosomes.
Symptoms of ectopic pregnancy
At first, you may have no symptoms. Early symptoms can resemble those of a typical pregnancy, including a missed period, abdominal discomfort and breast tenderness.
Only about half of women have all three main signs: a missed period, vaginal bleeding and abdominal pain.
Early signs include:
Upset stomach and vomiting
Severe abdominal cramps
Pain on one side of the body
Dizziness or weakness
Pain in the shoulder, neck or rectum
Signs of a ruptured ectopic pregnancy
An ectopic pregnancy can rupture a fallopian tube. Emergency symptoms include severe pain with or without heavy bleeding. Contact a doctor immediately if you have heavy vaginal bleeding with dizziness, fainting or shoulder pain, or severe abdominal pain, especially on one side.
You may need to call emergency services or go to the nearest hospital for immediate treatment.
When do symptoms begin?
Symptoms usually develop early in pregnancy, between weeks 4 and 12.
Locations of ectopic pregnancy
Although most occur in a fallopian tube, a fertilized egg can implant elsewhere outside the uterus.
Other types include:
Ovarian ectopic pregnancy (OEP)
This occurs when a fertilized egg implants on the outside of an ovary. OEP may be related to a problem with egg release during the menstrual cycle. An egg may be fertilized while still inside the ovarian follicle, or OEP may occur as the egg moves from a fallopian tube toward the ovary.
Abdominal ectopic pregnancy
Rarely, a pregnancy develops in the abdominal cavity between the abdominal wall and spine. Fluid movement in the abdomen may carry an egg behind the uterus, where sperm fertilizes it, or an embryo may travel from the reproductive tract to the abdomen through lymphatic channels.
Cervical ectopic pregnancy
This occurs when an egg implants in the cervical canal, possibly because of damage within the uterine cavity.
Cesarean scar ectopic pregnancy (CSEP)
CSEP occurs when a fertilized egg attaches to scar tissue from a cesarean delivery. Because scar tissue is more fragile than the uterine lining, it may tear and cause heavy bleeding.
Symptoms of these ectopic pregnancies, including vaginal bleeding and lower abdominal pain, resemble those of a tubal pregnancy.
Causes of ectopic pregnancy
The cause may never be known. One possible cause is a damaged fallopian tube that prevents a fertilized egg from reaching the uterus.
Risk factors for ectopic pregnancy
Risk is higher if you:
Smoke
Are over age 35
Have a sexually transmitted infection
Have scarring from pelvic surgery
Have had an ectopic pregnancy
Have undergone tubal ligation or tubal-ligation reversal
Have received fertility treatment such as in vitro fertilization (IVF)
These factors make ectopic pregnancy more likely.
An ectopic pregnancy may also occur if you become pregnant while using an intrauterine device (IUD).
Ectopic pregnancy and endometriosis
Endometriosis is a painful condition in which tissue similar to the uterine lining grows outside the uterus, commonly on the ovaries, fallopian tubes and pelvic lining. Scarring from the condition may prevent a fertilized egg from reaching the uterus and cause an ectopic pregnancy.
Complications
In an ectopic pregnancy, the fertilized egg is enclosed in a structure that can grow outside the uterus for several weeks, but it usually ruptures between 6 and 16 weeks. Rupture can cause severe bleeding. If bleeding is not stopped, excessive blood loss may cause the body to shut down (hemorrhagic shock), increasing the risk of death. Treatment before rupture is rarely fatal.
Rupture may damage the affected fallopian tube, which may need to be removed surgically. Because there are two fallopian tubes, pregnancy may still be possible if the other is healthy. If it is damaged or absent, fertility problems may occur. In that case, discuss other ways to become pregnant, such as IVF, with a doctor.
Diagnosis
A doctor may perform tests including a pregnancy test and pelvic examination, and may use ultrasound to examine the uterus and fallopian tubes.
Ultrasound is a noninvasive test that uses sound waves to create images inside the uterus. A sonographer may perform it through the vagina or abdomen. The clinician looks for a gestational sac, its location and a fetal heartbeat. The test is painless and usually takes about 15 to 20 minutes.
An abdominal ultrasound, performed by moving a probe over the abdomen, may confirm pregnancy or check for internal bleeding.
Treatment
Because a fertilized egg cannot survive outside the uterus, it must be removed to prevent serious health problems. Treatment uses medication or surgery.
Methotrexate treatment
If the fallopian tube has not ruptured and the pregnancy is not advanced, a doctor may give an injection of methotrexate (Trexall). One dose may be sufficient. It stops the fertilized egg from growing, and the body absorbs the tissue over about 4-6 weeks without removing the fallopian tube.
Before methotrexate, blood tests are needed to measure hCG (human chorionic gonadotropin), a hormone produced during pregnancy. Methotrexate cannot be used while breastfeeding or with certain health conditions.
After the injection, hCG levels are checked at follow-up visits. If they do not fall after the first dose, a second dose may be needed. Follow-up continues until hCG is no longer detected in the blood.
Methotrexate treatment differs from medication abortion, which may be used for a viable pregnancy implanted in the uterus. Medication abortion uses two prescription drugs: mifepristone and misoprostol.
Using methotrexate before an ectopic pregnancy ruptures is medically necessary and reduces the risk of death or other serious complications.
Surgical treatment
In other cases, surgery is required. Laparoscopic surgery is most common. The doctor makes very small incisions in the lower abdomen and inserts a thin, flexible tube called a laparoscope to remove the ectopic pregnancy. A damaged fallopian tube may also need to be removed. Heavy bleeding or suspected tubal rupture may require emergency surgery through a larger incision, called laparotomy.
Possible surgical side effects include:
Pain
Bleeding
Infection
After methotrexate or surgery, fatigue and abdominal discomfort may last several weeks, and pregnancy-like symptoms may continue temporarily. Menstrual cycles may take several months to return to normal.
After an ectopic pregnancy
A future intrauterine pregnancy may be more difficult, especially after removal of a fallopian tube. Consider speaking with a fertility specialist.
Ask your doctor how long to wait before trying again. Some experts recommend at least 3 months to allow the body to recover.
A previous ectopic pregnancy increases the risk of another. If you think you are pregnant again, monitor changes in your body and contact a doctor for confirmation and appropriate care.
Ectopic pregnancy can also affect mental health. Do not hesitate to seek support from a mental health professional, such as a licensed counselor or therapist.
How to reduce the risk
Ectopic pregnancy cannot be prevented, but certain lifestyle choices may reduce the risk.
You can:
Use condoms during sex to reduce the risk of pelvic inflammatory disease and sexually transmitted infections.
Avoid vaginal douching. Studies suggest that douching may increase the risk of ectopic pregnancy.