Ectopic Pregnancy: What to Know

Medically Reviewed by Jabeen Begum, MD on January 08, 2024
8 min read

Usually, a fertilized egg attaches itself to the lining in your uterus. But with an ectopic pregnancy (also called extrauterine pregnancy), the fertilized egg grows outside your uterus. This can include other areas like a fallopian tube, the ovaries, in your belly, or the lower part of your cervix, which is above the vagina. In more than 90% of cases, the egg attaches itself in a fallopian tube. This is called a tubal pregnancy.

How common are ectopic pregnancies? 

Rates are hard to determine, but one study suggests that about 1 in 50 pregnancies in the U.S. are ectopic. As the fertilized egg grows, it can burst (rupture) and can cause life-threatening bleeding. If this happens, you will need medical care right away. If you don't treat it, it can be deadly. In fact, ectopic pregnancies are the leading cause of pregnancy-related deaths in the first trimester.

Can a baby survive an ectopic pregnancy?

No. It's important to note that the fertilized egg in an ectopic pregnancy is not "viable." That means it's impossible for the egg to survive and grow into a baby that can survive in or outside your body. It will always result in a pregnancy loss. That's because the egg can't get the blood supply and support it needs to grow outside of the uterus.

Ectopic pregnancy vs. miscarriage

A miscarriage is when you abruptly lose a pregnancy before the 20th week. So while an ectopic pregnancy ends in a miscarriage, miscarriages can happen for other reasons like extra or missing chromosomes. 

At first, you may not have any symptoms of an early ectopic pregnancy. They may seem very similar to those of a normal pregnancy. You might miss your period and have discomfort in your belly and tenderness in your breasts.

Only about half of women with an ectopic pregnancy will have all three of the main signs: a missed period, vaginal bleeding, and belly pain.

Early signs of an ectopic pregnancy include:

  • Upset stomach and vomiting
  • Sharp belly cramps
  • Pain on one side of your body
  • Dizziness or weakness
  • Pain in your shoulder, neck, or rectum

Signs of a ruptured ectopic pregnancy

An ectopic pregnancy can cause your fallopian tube to burst, or rupture. Emergency symptoms include major pain, with or without severe bleeding. Call your doctor right away if you have heavy vaginal bleeding with lightheadedness, fainting, or shoulder pain, or if you have severe belly pain, especially on one side.

You might need to call 911 or head to the nearest hospital to have it treated right away.

Symptoms of an ectopic pregnancy usually develop fairly early in the pregnancy: between the 4th and 12th weeks.

While most ectopic pregnancies happen in a fallopian tube, an egg can also attach itself to other areas outside of your uterus. Other types of ectopic pregnancy include:

Ovarian ectopic pregnancy (OEP)

When a fertilized egg implants on the outside of your ovary, it causes this type of ectopic pregnancy. OEP could happen because of problems with how your body releases eggs during your menstrual cycle. It's possible that an egg is fertilized while it's still in the follicle (a structure in the ovary), and OEP may happen as the egg moves from your fallopian tube to your ovary.

Abdominal ectopic pregnancy

In rare cases, a pregnancy happens in the space between your abdominal wall and spine (abdominal cavity). With this type of ectopic pregnancy, the movement of fluid in the abdomen may transport an egg behind the uterus where a sperm fertilizes it. Or an embryo might move from the reproductive tract to the abdominal cavity by traveling through lymphatic channels.

Cervical ectopic pregnancy

This type of ectopic pregnancy happens when an egg implants in the cervical canal, and may happen because of damage to the space inside your uterus (uterine cavity).

Cesarean scar ectopic pregnancy (CSEP)

CSEP is when a fertilized egg attaches to scar tissue from a C-section. Since scar tissue is weaker than the lining of your uterus, it can tear and cause heavy bleeding.

Symptoms of these ectopic pregnancies, like bleeding from your vagina and lower belly pain, are similar to the kind that happen in your fallopian tube.

You may never know why you have an ectopic pregnancy. One cause could be a damaged fallopian tube. It could keep the fertilized egg from getting into your uterus.

You're more likely to have an ectopic pregnancy if you:

  • Smoke cigarettes
  • Are older than 35
  • Have a sexually transmitted infection
  • Have scarring from pelvic surgery
  • Had a previous ectopic pregnancy
  • Tried to have tubal ligation (tubes tied) or tubal ligation reversal
  • Had fertility treatments such as in vitro fertilization (IVF)

It could also happen if you become pregnant while you have an intrauterine device (IUD) for birth control.

Endometriosis is a painful condition where tissue like the kind found lining your uterus grows outside of the uterus. It usually forms on the ovaries, fallopian tubes, and tissue lining the pelvis. Scarring from the condition may stop a fertilized egg from reaching the uterus, causing an ectopic pregnancy.

During an ectopic pregnancy, the fertilized egg is wrapped in a structure that can grow for several weeks outside your uterus. But the structure usually bursts between 6 and 16 weeks. A ruptured ectopic pregnancy can cause severe bleeding. If the bleeding isn't stopped, your body might start to shut down due to the blood loss (hemorrhagic shock), and the odds of dying from it increase. If it's treated before it bursts, it rarely results in death.

If the structure does burst, it may damage the fallopian tube it was attached to. Your doctor might remove the fallopian tube during the surgery. But you have two fallopian tubes. If your other fallopian tube is healthy, you should still be able to get pregnant. But if your other fallopian tube is damaged or not there, you may have fertility issues. In this case, talk to your doctor about other ways to get pregnant, like IVF (in vitro fertilization).

Your doctor will probably do tests that include a pregnancy test and a pelvic exam. They might give you an ultrasound to look at your uterus and fallopian tubes.

An ultrasound for ectopic pregnancy is a noninvasive test that uses sound waves to create images of the inside of the uterus. The test is performed by a sonographer and may be done transvaginally or transabdominally. During the ultrasound, the doctor will look for the presence of a gestational sac, the location of the gestational sac, and whether there is a fetal heartbeat. The test is painless and usually takes around 15 to 20 minutes.

An abdominal ultrasound test, which is performed by moving a wand over the abdomen, may be used to confirm pregnancy or check for internal bleeding.

Because a fertilized egg can't survive outside a uterus, your doctor will need to take it out, so you don't have serious health problems. They'll use one of two methods: medication or surgery.

Methotrexate for ectopic pregnancy
If your fallopian tube hasn't ruptured and your pregnancy isn't far along, your doctor can give you a shot of methotrexate (Trexall). You only need one dose of the injection. It stops the fertilized egg from growing. Your body will absorb the egg in about 4-6 weeks. With this treatment, there's no need to remove the fallopian tube.

Before you can take methotrexate, your doctor will need to run a few blood tests to measure your levels of hCG (human chorionic gonadotropin). It's the hormone your body makes when it detects a pregnancy. You won't be able to take methotrexate if you're breastfeeding or have certain health problems.

Once you get the shot, the doctor will check your hCG levels during follow-up appointments. If your levels don't drop after the first dose, you might need a second dose of the same medication. You'll need to follow up until your blood no longer has hCG.

It's important to note that taking methotrexate is not the same as having a medical abortion, as you could get if you had a "viable" pregnancy in which the fertilized egg attaches inside the uterus. For a medical abortion, you need a combination of two prescription drugs: mifepristone and misoprostol.

The methotrexate that you take during an ectopic pregnancy before the egg bursts is medically necessary. It can lower your risk of dying or other serious complications.

Surgery for ectopic pregnancy

In other cases, you'll need surgery. The most common is laparoscopy. Your doctor will make very small cuts in your lower belly and insert a thin, flexible tube called a laparoscope to remove the ectopic pregnancy. If your fallopian tube is damaged, they may have to remove it as well. If you're bleeding a lot or your doctor suspects that your fallopian tube is ruptured, you might need emergency surgery with a larger cut. This is called a laparotomy.

Surgery side effects can include:

  • Pain
  • Bleeding
  • Infection

Whether you take methotrexate or have surgery, you may feel tired for a few weeks and have some discomfort in your belly. You may continue to have pregnancy-like symptoms for a bit. It might take a few period cycles before you feel back to normal.

It might be hard for you to have a typical pregnancy afterward. Consider talking to a fertility specialist, especially if you had a fallopian tube removed.

And talk to your doctor about how long to wait before trying again. Some experts suggest giving yourself at least 3 months so your body has time to heal.

An ectopic pregnancy raises your risk of having another one. If you think you're having another pregnancy, be mindful of the changes in your body. Check with your doctor, and they can confirm it and take the necessary steps.

An ectopic pregnancy can take a toll on your mental health, too. Don't hesitate to reach out to mental health experts like a licensed counselor or therapist.

There's no way to prevent an ectopic pregnancy. But you can lower your odds with certain lifestyle choices.

You can:

  • Use a condom when you have sex. This can lower your risk for pelvic inflammatory disease and sexually transmitted infections.
  • Avoid using a vaginal douche. Studies show that using a douche can increase the risk of ectopic pregnancy.