Ectopic Pregnancy

Reproductive Tubal pregnancy

A pregnancy that implants outside the uterus — most often in a fallopian tube — which can rupture and bleed.

Educational summary only — not medical advice, and no substitute for assessment by a clinician. Diagrams are simplified illustrations.

A fertilized egg implants in the narrow fallopian tube instead of the uterus; as it grows, it stretches the tube, which can rupture.

Overview

In a normal pregnancy, a fertilised egg travels down the fallopian tube and implants in the lining of the uterus. In an ectopic pregnancy, it implants somewhere else — most often inside the narrow fallopian tube, which is not built to hold a growing pregnancy. It usually becomes apparent in the early weeks and can be dangerous, so early recognition is vital.

How the system normally works

Each month an egg is released from an ovary and picked up by the nearby fallopian tube, where fertilisation may occur. The early embryo is then wafted along the tube into the spacious, cushioned uterus to implant and grow.

What goes wrong

If the tube is scarred or not moving the embryo along properly, the pregnancy can implant inside the tube. The tube is narrow and cannot stretch like the uterus, so as the pregnancy grows it stretches and can rupture the tube, causing sudden, serious internal bleeding. Ectopic pregnancies cannot move to or survive in the uterus.

Diagram comparing a normal pregnancy implanted in the uterus with an ectopic pregnancy implanted in the fallopian tube. — Normally the embryo implants in the cushioned uterine lining; in an ectopic pregnancy it lodges in the narrow tube, which cannot expand safely.

Symptoms and why they happen

One-sided lower belly or pelvic pain — the stretched tube.
Vaginal bleeding or spotting, usually with a positive pregnancy test.
Shoulder-tip pain — internal bleeding irritating the diaphragm, felt at the shoulder.
Dizziness or fainting — blood loss; a sign of possible rupture.
Symptoms may be subtle at first and easily mistaken for an early miscarriage or stomach upset.

Causes and risk factors

Previous tubal infection (pelvic inflammatory disease)
Previous ectopic pregnancy or tubal surgery
Endometriosis
Becoming pregnant with an IUD in place, or after fertility treatment
Smoking

How it's diagnosed

A pregnancy test plus transvaginal ultrasound to locate the pregnancy, supported by serial blood hormone (hCG) measurements when the early scan is inconclusive. The combination usually identifies a pregnancy that is not in the uterus.

Diagram of a ruptured tubal ectopic pregnancy with the torn fallopian tube bleeding into the pelvic space. — If it grows unchecked, the pregnancy can split the tube open, causing serious internal bleeding into the pelvis — a surgical emergency.

Treatment and management

Options depend on how advanced and stable things are: close monitoring for a very early, resolving pregnancy; medication (methotrexate) to stop the pregnancy growing in suitable early cases; or surgery (usually keyhole) to remove the ectopic pregnancy, sometimes with the affected tube. A ruptured ectopic needs emergency surgery.

Possible complications

Tubal rupture with heavy internal bleeding is the major danger and can be life-threatening. There may be effects on future fertility, though many people go on to have normal pregnancies.

Prevention and outlook

Prevention focuses on reducing tubal damage — preventing and promptly treating sexually transmitted infections, and not smoking. With early diagnosis the outlook is good; the risk lies in delay, so any positive pregnancy test with pain or bleeding should be assessed promptly.

When to seek emergency care

Severe pelvic pain, faintness, or collapse in early pregnancy — possible rupture; emergency.
Shoulder-tip pain with a positive pregnancy test and bleeding.