Ectopic pregnancy

This page aims to explain how we diagnose an ectopic pregnancy. 

Sadly, an ectopic pregnancy cannot survive and losing a pregnancy in this way affects everybody differently. The diagnosis of an ectopic is often unexpected, and can be a stressful and distressing time. We want to ensure you are well supported whilst in hospital or under the care of the early pregnancy clinic (EPC).

You will be looked after by a team of doctors and nurses, and although we try hard to ensure continuity this is not always possible. Please let us know if you need additional information or support during this time.

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that develops outside the cavity of the womb. Most ectopic pregnancies occur in the fallopian tube (95%), however they can occur in other places (such as the ovary, the cervix, and inside the tummy). Since the fallopian tubes are not large enough for the growing pregnancy so it cannot continue normally. 

What are the causes of ectopic pregnancy?

Most ectopic pregnancies occur because the fertilized egg cannot pass through the fallopian tubes, this occurs for many reasons:

• an infection or inflammation of the tube may have partially or entirely blocked it
• Pelvic inflammatory disease (PID) is a common infection
• damage due to a previous ectopic pregnancy
• endometriosis or scar tissue (adhesions) from previous abdominal surgery or previous operations on the tubes including reversal of sterilisation

However, in many patients a cause cannot be found.

What are the symptoms of an ectopic pregnancy?

Symptoms of an ectopic pregnancy can often be vague, and difficult to diagnose because they mirror those of a normal early pregnancy. These can include:

• missed or late periods.
• irregular vaginal bleeding.
• abdominal pain.
• sharp pain in the abdomen (tummy) or pelvis which may be intermittent or constant (often one-sided).
• shoulder pain.
• dizziness or fainting.
• loose stools (poo) or diarrhoea

How is an ectopic pregnancy diagnosed?

If you come to the hospital with symptoms that suggest an ectopic pregnancy we may do the following tests: 

• If pregnancy has not already been confirmed, a pregnancy test will be done.
• A pelvic examination (feeling your tummy) by a nurse/ doctor may locate the areas causing pain.
• An ultrasound scan and often a vaginal scan (which may give better images) will be done to find out if there is a pregnancy inside the womb. 
• If we cannot see anything in the womb on scan and the pregnancy test is positive, an ectopic pregnancy has to be considered.
• It may just be that the pregnancy is too early to see on a scan or that a miscarriage might have already occurred, but the diagnosis of ectopic pregnancy cannot be ruled out. 
• Even with the best equipment, it is hard to see a pregnancy less than 6 weeks or an ectopic pregnancy.
• Blood levels of a hormone produced by the pregnancy may need to be assessed by a blood test. In normal pregnancy, the level of hormone nearly doubles about every two to three days during the first 10 weeks of pregnancy. 
• In an ectopic pregnancy, the levels climb slowly or stay the same (this can vary and sometimes the levels can rise or fall). 
• We may need to carry out a series of blood tests over a period of days to check these levels. An abnormal pattern in the rise of this hormone can be due to an ectopic pregnancy or sometimes a miscarriage.

The most important information while we are looking after you are your symptoms (how you feel).

You must let us know if your pain increases or if you develop any worrying symptoms (see the symptoms of ectopic pregnancy above).

Can an ectopic pregnancy cause me to be very unwell?

It is rare, but yes it can. In some cases, the embryo grows until the fallopian tube stretches and ruptures (bursts). Rupture of the fallopian tube is a medical emergency because of internal bleeding, causing abdominal pain and the risk of a person collapsing (fainting and being unwell).

Please be reassured, most people are diagnosed early and managed very safely. But your symptoms are so important because there have been cases where people have been so severely unwell that they have died due to an ectopic pregnancy. 

How will an ectopic pregnancy be treated?

There are 3 ways of treating/managing an ectopic pregnancy:

Conservative management: this involves no active medical or surgical treatment; you are simply kept under observation and may be allowed to stay at home or offered a bed in hospital.

Medical management: this involves an injection of a drug called methotrexate to resolve your ectopic pregnancy (separate leaflet available).

Surgical management: this is usually done through keyhole surgery (laparoscopy) although occasionally abdominal surgery (laparotomy) is needed.

Conservative management – ‘watching and waiting’

Conservative management means we expect your ectopic pregnancy to end naturally without treatment. Instead of immediate medical or surgical care, we will monitor you closely with regular blood tests to check that your pregnancy hormone levels are falling back to normal. This approach is commonly used, and more than half of ectopic pregnancies resolve on their own. While we take a “wait and see” approach, you will have 24-hour access to advice and support, so you can get help at any time if you have concerns.

Research has shown that in patients who are properly assessed, where their pregnancy hormone level (hCG) is dropping, up to 50% of these pregnancies will end naturally - so there will be no need for an operation or drugs.

Conservative management is the best treatment when:

• the hormone beta hCG (produced by a pregnancy) is low
• general health appears to be stable
• pain levels are considered to be acceptable
• an ultrasound scan shows a small ectopic pregnancy with no worrying bleeding into the tummy

What are the advantages of conservative management?

• You do not have to stay in hospital.
• It avoids medication/surgery with a general anaesthetic and the possible associated risks and side effects.

What are the disadvantages of conservative management?

• Further visits to the hospital are required which may include blood tests or scans.
• Medical or surgical management may be required if the pregnancy continues to develop.
• If the pregnancy continues to develop the tube may rupture and you will need emergency surgery.

Whilst at home it is important to tell Cotswold Ward or Early Pregnancy Clinic if: 

• you experience any increase in pain
• you experience pain somewhere you have not previously had it, for example, shoulder tip pain or rectal pain.
• you feel faint or dizzy

Medical management of ectopic pregnancy

Medical treatment of ectopic pregnancy is also used commonly and may avoid the need for surgery.

Methotrexate is a drug normally used in cancer treatment but the amount used is very small. It works because it kills the rapidly growing cells of an ectopic.  It has a good success rate for treating small ectopic pregnancies (more than 90 in 100) and avoids surgery. We have a separate leaflet that explains Methotrexate more fully.

Methotrexate cannot be used in all circumstances, and we will advise you as to the best treatment for you.

Side effects of the drug are: nausea/vomiting, diarrhoea, headaches, abdominal pains and bleeding. Repeated visits to the hospital are essential (with blood tests) and you may require a second dose of the drug. You will be advised to wait a minimum of 3 months before trying for a future pregnancy. 

How will I know if there is a problem and I need a different treatment?

We will do blood tests and scans. If the pregnancy is not resolving, they will suggest other forms of treatment for you. 

Will I experience any pain?

Yes, you might have some lower pelvic pain or backache at any time during the course of the management. If required you can take paracetamol, ibuprofen, and sometimes codeine. (Always read the label/instructions before taking them and do not take more than the maximum daily dose). 

If your pain is getting worse, or are taking pain relief and it is not helping, it is important to ring us.

Will I experience any vaginal bleeding?

Yes, this can vary from dark brown spotting to heavier bright red loss. Use sanitary towels rather than tampons to reduce the risk of infection. If you are concerned that the bleeding is excessive (changing pads every half an hour) please contact us.

Surgical management of ectopic pregnancy

What will surgery involve?

It involves an operation to remove the ectopic pregnancy and will be done under a general anaesthetic. Surgery to remove the ectopic pregnancy is the most well-established form of treatment (the one that has been done for the longest time). It may also be performed if conservative or medical management have failed. 

It is usually done through keyhole surgery (called a laparoscopy), which involves inserting a camera through the umbilicus (belly button) and inserting instruments through two small cuts in the lower abdomen (tummy).  A small amount of gas is put into your abdomen to inflate it to help the surgeon get a better view. There are times when a bigger cut in the tummy at the bikini line is needed (although not common).

The most common surgery is called ‘salpingectomy’ which is removal of the damaged fallopian tube. (In some cases where there are risk factors for infertility, the doctors may make different decisions about your care/management). 

If you are rhesus D negative blood group you will need an anti-D injection (we have a separate leaflet about this). 

You are often advised to take a home pregnancy test 3 weeks after your operation. If the test is positive, you should return for further checks. 

There may be occasions where the doctor requests a blood test 48 hours or 1 week after surgery. This is usually done in the Early Pregnancy Clinic.

How does surgery affect future pregnancies?

• Having an ectopic pregnancy whatever the treatment means there may be some damage to the tube and this will slightly reduce the chance of getting pregnant in the future.
• If you have had surgical treatment the chance of getting pregnant is about 70%, but it does depend on other factors such as the health of your remaining tube.
• Once you have had an ectopic pregnancy, although more likely to have a normal pregnancy - your chances of having another ectopic pregnancy are increased. 

Should I be off work during/after treatment?

This is a very individual decision. You will need to recover physically, and it will depend on how you are feeling emotionally. Please consider some time off work, especially in the first week when frequent visits to hospital may be required. You can self-certify for the first 5 days, or the staff in the hospital can issue you with a sick note (fit note).

Emotions

It is completely normal to feel a variety of emotions during this time. You may experience days when you feel completely ‘back to normal’, but you may also have days when you feel vulnerable and tearful. 

Pregnancy loss is not straightforward, and people all react and recover in different ways - there is no right or wrong way. It is important to give yourself time to recover on a physical and emotional level. 

If you wish to talk to someone about your feelings and are unable to do so with a partner, close friend or family member, a list of counselling services and support are included at the end of this leaflet.

What about future pregnancies?

• Studies have shown that there is a 7 in 10 (70%) chance of a normal pregnancy in the future irrespective of which way the ectopic pregnancy has been managed. 
• It is perfectly safe to start trying for another pregnancy once you and your partner feel ready. 
• If you have had methotrexate treatment then you will need to wait 3 months before trying for another pregnancy. If however, you have needed 2 doses of methotrexate you would need to wait for 6 months (see methotrexate leaflet).

In the future, If you think you are pregnant:

• do a urinary pregnancy test at home
• use the self referral form to refer yourself to EPC
• if you are very early in pregnancy (below 6 weeks) but have pain, please call the clinic for advice – or  self refer to the clinic and explain that you have had an ectopic pregnancy previously
• you have ‘open access’ to attend early pregnancy clinic when you are at least 6-7 weeks pregnant so we can perform a scan, there is an open access letter at the end of this leaflet

To be as healthy as possible when you are thinking of getting pregnant again, being healthy will really help. It is best to:

• take folic acid
• reduce/stop your alcohol and caffeine intake
• stop smoking

The list of support agencies below not exhaustive and inclusion does not imply endorsement. It is also worth remembering that many GPs have counselling services at their practices.

Further help and advice

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002434