When Ectopic Pregnancy Symptoms Start

What Are The Signs And Symptoms Of An Ectopic Pregnancy

Ectopic Pregnancy – Overview (pathophysiology, signs and symptoms, treatment, investigations)

Signs of a condition are things someone else can see or know about you, like you have a rash or youre coughing. Symptoms are things you feel yourself that others cant see, like having a sore throat or feeling dizzy.

An ectopic pregnancy may start out with usual signs and symptoms of pregnancy, like missing your period or having nausea and tender breasts. Or you may not have any signs or symptoms and not even know youre pregnant.

  • Bleeding from the vagina
  • Feeling faint or dizzy. This can be caused by blood loss which can cause low blood pressure. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body.
  • Pain in your lower back or even your shoulder
  • Pain in your pelvic area . The pain may be mainly on one side. It can come and go, start out mild and then become sharp and stabbing.

Medical Treatment With Methotrexate

Medical treatment is useful for patients with an unruptured tubal ectopic pregnancy who are haemodynamically stable and have minimal symptoms and a low volume of free intraperitoneal fluid on ultrasound scan.70 Intramuscular methotrexate is the most widely used and successful medical therapy for ectopic pregnancy and is generally administered in a single-dose protocol.34,69 Methotrexate is a folic acid antagonist that targets rapidly dividing cells and arrests mitosis.9,71 In ectopic pregnancy, the drug prevents the proliferation of cytotrophoblast cells, reducing cell viability and -hCG secretion and thus progesterone support for the pregnancy. This facilitates the resolution of the ectopic pregnancy and tissue remodelling.

After assessing patient suitability for medical management , body surface area is calculated using height and weight measurements. In addition, a baseline full blood count and renal and liver function tests are obtained. In general, apart from some abdominal discomfort 1-3 days after treatment and abdominal bloating, side effects are not common and return to normal activities is quicker than after surgery. Potential serious side effects such as significant hepatotoxicity, bone marrow toxicity or alopecia are extremely rare with ectopic pregnancy treatment regimens. Patients require careful monitoring to ensure complete resolution of the ectopic gestation using serial assessment of -hCG levels every 4-7 days until the -hCG level is < 5 IU/l.72

Diagnosis Of Ectopic Pregnancy

Sometimes ectopic pregnancies have no symptoms. This means an ectopic pregnancy can be difficult to diagnose.

At the hospital a doctor or midwife will ask you questions about your symptoms. They’ll want to know the date of your last period. Your doctor will also examine your tummy by pressing on it.

Your doctor may need to do a vaginal exam. They will ask you for your consent to do this. You can bring your partner with you to the examination if you wish.

You might have the following tests to help diagnose an ectopic pregnancy:

  • urine test
  • laparoscopy

It can take more than one visit to a maternity hospital to make a diagnosis.

Sometimes when you first visit the hospital it’s not possible for your obstetrician or midwife to see exactly where the pregnancy is. This is called a ‘pregnancy of unknown location‘.

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Who Develops An Ectopic Pregnancy

Ectopic pregnancy can occur in any sexually active woman. In the UK there are nearly 12,000 women with ectopic pregnancies seen in hospitals each year. The chance is higher than average in the following at-risk groups:

  • If you have already had an ectopic pregnancy you have a slightly higher chance that a future pregnancy will be ectopic. If you have had two or more ectopic pregnancies then your chances of another ectopic pregnancy are even greater.
  • If you have damage to, or other abnormality of a Fallopian tube. This is because a fertilised egg may become stuck in the tube more easily. For example:
  • If you have had a previous infection of the womb or Fallopian tube . This is most commonly due to either chlamydia or gonorrhoea. These infections can lead to some scarring of the Fallopian tubes.
  • Previous sterilisation operation. Sterilisation is a very effective method of contraception. However, in the rare event that a pregnancy does occur, it has a higher risk of being ectopic.
  • Any previous surgery to a Fallopian tube or nearby structures.
  • If you have a condition causing inflammation of the uterus and surrounding area .
  • If you use an intrauterine contraceptive device . Pregnancy is rare as this is a very effective method of contraception. However, if you become pregnant while using an IUCD, the pregnancy has a higher chance of being ectopic than if you did not have the IUCD.
  • If you are using assisted conception .
  • Medical Management With Methotrexate For Ectopic Pregnancy

    When Ectopic Pregnancy Symptoms Start

    Sometimes, an ectopic pregnancy may be treated with a medication called methotrexate. This stops the growth of the embryo and typically allows surgery to be avoided. Medical management may be suitable if a diagnosis has been made very early.

    Treatment with methotrexate is an especially attractive option if the pregnancy is located in the cervix or ovary or in the interstitial or the cornual portion of the tube. Surgical treatment in these cases is often associated with an increased risk of hemorrhage.

    Methotrexate is administered as an injection, usually a single shot into the buttock muscle. After the injection, there may be an overnight stay in hospital, and regular follow-up visits will be needed for a few weeks to monitor hCG levels until they return to normal. Some people will need a second injection of methotrexate. Very occasionally, surgery will still be required.

    Some pain is likely in the first few days after the injection, but this can usually be controlled with paracetamol. Certain substances should be avoided during treatment, including:

    • Nonsteroidal antiinflammatory drugs , e.g., ibuprofen or naprosyn, as they can interact with methotrexate and reduce its effectiveness
    • Alcoholic beverages, as the liver will be working hard to metabolise methotrexate
    • Supplements containing folic acid, as this can interact with methotrexate, preventing it from achieving the desired effect

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    Do I Have An Ectopic Pregnancy

    Getting checked out by a doctor is the only way to know for sure if you have an ectopic pregnancy. Your doctor or nurse may do a pelvic exam, blood test, or ultrasound to find out.

    The sooner you get treated for an ectopic pregnancy, the better. So if you think you have an ectopic pregnancy, or if you have lots of low belly pain or abnormal vaginal bleeding, call your nurse or doctor right away.

    Cramping And Spotting During Early Pregnancy

    From weeks 1 to 4, everything is still happening on a cellular level. The fertilized egg creates a blastocyst that will develop into the fetuss organs and body parts.

    About 10 to 14 days after conception, the blastocyst will implant in the endometrium, which is the lining of the uterus. This can cause implantation bleeding, which may be mistaken for a light period. It does not occur for everyone. If it does occur, it will usually happen around the time you expect your period.

    Here are some signs of implantation bleeding:

    • Color. The color of each episode may be pink, red, or brown.
    • Bleeding. Implantation bleeding is usually much less than your usual period. Its often described as light bleeding that never turns into a flow or enough to need a tampon.
    • Pain. Pain is usually milder than your usual menstrual pain. It may involve some cramping. It can be moderate or severe, but its most often mild.
    • Episodes. Implantation bleeding is likely to last less than 3 days and does not require treatment. It can sometimes last only a few hours.

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    After An Ectopic Pregnancy

    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 youre 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. Dont hesitate to reach out to mental health experts like a licensed counselor or therapist.

    Theres 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 PID and other sexually transmitted infections

    Treatment For An Ectopic Pregnancy

    What is the First Sign of an Ectopic Pregnancy?

    An ectopic pregnancy cant be relocated to the uterus. Depending on the location and stage of your ectopic pregnancy, we treat you with medication or surgery.

    The medication we use for an ectopic pregnancy stops further growth of the egg, which your body then reabsorbs. For surgery, we use minimally invasive techniques to perform a salpingostomy or a salpingectomy .

    Whether treated with medication or surgery, we schedule regular follow-up appointments to monitor you and your health after treatment.

    When left untreated, an ectopic pregnancy may lead to life-threatening internal bleeding. Knowing the signs and symptoms helps you get an early diagnosis and the treatment you need right away.

    To schedule an appointment with one of our experienced OB/GYNs, call us or book an appointment online at the office nearest you.

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    Why Does An Ectopic Pregnancy Happen

    In a normal pregnancy an egg is fertilised by sperm in one of the fallopian tubes, which connect the ovaries to the womb. The fertilised egg then moves into the womb and implants itself into the womb lining , where it grows and develops.

    An ectopic pregnancy occurs when a fertilised egg implants itself outside the womb. It most commonly occurs in a fallopian tube , often as the result of damage to the fallopian tube or the tube not working properly.

    Less commonly , an ectopic pregnancy can occur in an ovary, in the abdominal space or in the cervix .

    In many cases, it’s not clear why a woman has an ectopic pregnancy. Sometimes it happens when there’s a problem with the fallopian tubes, such as them being narrow or blocked.

    The following are all associated with an increased risk of ectopic pregnancy:

    In around half of all cases, there are no obvious risk factors.

    Missed Period During Early Pregnancy

    Once implantation is complete, your body will begin making human chorionic gonadotropin . This hormone helps the body maintain the pregnancy. It also tells the ovaries to stop releasing mature eggs each month.

    You will likely miss your next period 4 weeks after conception. If you typically have an irregular period, youll want to take a pregnancy test to confirm.

    Most home tests can detect hCG as soon as 8 days after a missed period. A pregnancy test will be able to detect hCG levels in your urine and show if you are pregnant.

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    How Is An Ectopic Pregnancy Treated

    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 . The surgeon may remove the entire fallopian tube with the egg still inside it or remove the egg from the tube if possible.

    What Are The Early And Later Signs And Symptoms Of Ectopic Pregnancy

    Signs of an Ectopic Pregnancy
    • dizziness, and
    • a sense of passing out upon standing can be signs of serious internal bleeding and low blood pressure from a ruptured ectopic pregnancy and require immediate medical attention.

    Unfortunately, some women with a bleeding ectopic pregnancy do not recognize they have symptoms of ectopic pregnancy. Their diagnosis is delayed until the woman shows signs of shock and often is brought to an emergency department. This situation is a medical emergency.

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    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.
    • 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 in place, or have a history of a tubal ligation , contact your healthcare provider right away. Ectopic pregnancy is more common in these situations.

    If My Fallopian Tube Is Removed Can I Still Have A Baby

    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 .

    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.


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    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
    • 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 might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also increase the risk of an ectopic pregnancy.

    Vaginal Spotting Or Bleeding

    Ectopic pregnancy symptoms

    One of the first warning signs of an ectopic pregnancy is spotting or bleeding. Although bleeding in early pregnancy does not always mean there is something wrong with the pregnancy, if you have spotting or bleeding, you should report this to your doctor. Some other causes of spotting during pregnancy are implantation bleeding, subchorionic hematoma, irritation of the cervix, or miscarriage.

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    How To Recognize And Treat An Ectopic Pregnancy

    Ectopic pregnancies are relatively rare, but because they can be deadly, its important to know the warning signs.

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    This guide was originally published on May 3, 2019 in NYT Parenting.

    An ectopic pregnancy occurs when a fertilized egg implants and grows in the wrong place. Instead of implanting in the uterus, it lands elsewhere almost always in a fallopian tube, but rarely in other unusual locations, such as in the cervix or ovary. Left untreated, a growing ectopic pregnancy can cause life-threatening internal bleeding, and could eventually rupture the fallopian tube its housed in.

    The good news is that ectopic pregnancies are relatively uncommon, occurring in just about 1 to 2 percent of pregnancies in the United States. For someone without the risk factors, chances are they are not going to have an ectopic pregnancy, said Dr. Jeffrey Ecker, M.D., chief of the department of obstetrics and gynecology at Massachusetts General Hospital. Still, its important to know if youre at risk, and to understand the signs and symptoms, and what to do if you experience them.

    Rectal Pressure Gas Pain Or Feeling Constipated

    Sometimes the pain from an ectopic can be mistaken for gas pain or constipation. If internal bleeding has occurred, this can put pressure on the rectal area and can be mistaken for gas pain or constipation. If you are having severe gas pain during early pregnancy donât dismiss this. Call your doctor.

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    Early Changes To Breasts: Tingling Aching Growing

    Breast changes can occur between weeks 4 and 6. Youre likely to develop tender and swollen breasts due to hormone changes. This will likely go away after a few weeks when your body has adjusted to the hormones.

    Nipple and breast changes can also occur around week 11. Hormones continue to cause your breasts to grow. The areola the area around the nipple may change to a darker color and grow larger.

    If youve had bouts with acne before your pregnancy, you may experience breakouts again.

    Can Ectopic Pregnancy Be Detectable Easily

    What is Ectopic Pregnancy: Symptoms &  Treatment

    Usually, it is difficult to notice any difference between normal and ectopic pregnancy in the first few weeks. But as soon as you experience any symptoms must seek a gynecologist for early detection of the abnormal pregnancy as it can be a life hazard for the mother if not diagnosed or treated. A doctor at Jaslok hospital may recommend blood tests to check your status from the start.

    • Blood test Your doctor uses a blood test to validate your HCG levels. The HCG levels in an ectopic pregnancy stay low, but in a normal pregnancy, the levels double every 48 hours in the first several weeks. In this approach, frequent blood tests inform your doctor about the likelihood of an ectopic pregnancy developing.
    • Pelvic Ultrasound A transvaginal ultrasound can confirm an ectopic pregnancy a few weeks after conception. The radiologist inserts a piece of wand-like equipment into your vagina to generate pictures of the uterus through sound waves and assess the pregnancy.

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