these symptoms and do not suspect that they
might be pregnant.
Ectopic pregnancy
Reviewed by Dr Philip Owen, consultant
obstetrician and gynaecologist
What is an ectopic
pregnancy?
An ectopic pregnancy occurs when the
fertilised egg attaches itself outside the
cavity of the uterus (womb).
The majority of ectopic pregnancies are
found in the Fallopian tubes.
In rare cases, the egg attaches itself in one of
the ovaries, the cervix (neck of the womb)
or another organ within the pelvis. An
ectopic pregnancy is not usually capable of
surviving and in most instances an embryo
is not developed. An ectopic pregnancy will
spontaneously miscarry.
The majority of women diagnosed will have
to be operated on or treated with medication.
What are the symptoms of
an ectopic pregnancy?
The most common symptoms and findings
of ectopic pregnancy are:
• an overdue period (suggesting
pregnancy)
• bleeding from the vagina
• positive pregnancy test
• lower abdominal pain
• fainting.
At first an ectopic pregnancy develops like a
normal pregnancy and the same symptoms
such as nausea and tender breasts will be
present. However, some women do not have
The vaginal bleeding can vary from being
slight or brown vaginal discharge to being
like a normal period.
If you are pregnant and have a long-lasting
throbbing in one side of your lower
abdomen or if you experience sudden pain
you should contact your doctor. This is
important because an ectopic pregnancy can
be life-threatening if it ruptures and causes
internal bleeding.
Why does an ectopic
pregnancy occur?
In a normal pregnancy, the egg is fertilised
by the man's sperm in the Fallopian tube and
is then transported into the cavity of the
womb where it attaches itself. This is called
implantation. This transportation is made
possible by the tiny cilia (finger-like
projections) in the delicate inner lining of
the Fallopian tubes that push the fertilised
egg along.
Risk factors may be present that increase the
likelihood of a woman experiencing an
ectopic pregnancy. These are:
• previous surgery to the
Fallopian tubes or previous
inflammation of the Fallopian
tubes (pelvic inflammatory
disease). Because the lining of
the Fallopian tubes is so
delicate, inflammation or
trauma can cause the cilia to
beat in an abnormal fashion so
that the fertilized egg implants
in the wrong place.
• previous ectopic pregnancy. If
you have previously had an
ectopic pregnancy, the chances
of another one in the same
 Fallopian tube and in the other
tube are increased.
• becoming pregnant while using
a contraceptive coil or the
progestogen-only contraceptive
pill (mini-Pill).
• becoming pregnant with in vitro
fertilisation (test-tube methods).
When using the test-tube
method to overcome infertility
one or more eggs are inserted
into the woman's uterus.
Despite being placed within the
womb, the fertilised egg may
still attach itself to the wrong
area outside the cavity of the
uterus.
However, many women experiencing an
ectopic pregnancy do not have any of these
risk factors.
How is an ectopic pregnancy
diagnosed?
A urine test for pregnancy will nearly
always be positive but it might be only
weakly positive. In cases of doubt, a blood
pregnancy test may be performed, which is
always positive in ectopic pregnancy.
In the case of ectopic pregnancy, the uterus
will often be smaller than expected for the
number of weeks since the woman's last
period and this can be checked by an
internal pelvic examination. The doctor
might feel a tender swelling corresponding
to an ectopic pregnancy.
An ultrasound scan will help the doctor
differentiate between a possible miscarriage,
a continuing pregnancy inside the womb and
an ectopic pregnancy.
Further investigation depends on the
woman's symptoms, the scan findings and
the level of pregnancy hormone (HCG) in
the woman's blood. If there is uncertainty
about the diagnosis then waiting 48 hours
and measuring the level of HCG again is
often appropriate.
How is an ectopic pregnancy
treated?
If an ectopic pregnancy is strongly suspected
then the gynaecologist will perform a
laparoscopy to confirm the diagnosis.
Laparoscopy is performed through small
incisions on the abdomen and the ectopic
pregnancy can usually be removed in this
manner.
The Fallopian tube in which the ectopic
pregnancy occurred is often, but not always,
removed at the same time. However, in
some instances, open surgery becomes
necessary in which the pregnancy is
removed through a larger incision above the
pubic hair line. This option is usually chosen
if technical problems occur during the
laparoscopy or if the internal bleeding in the
abdominal cavity is difficult to control.
An alternative treatment to surgery is a
medicine called methotrexate (Maxtrex),
which decreases the growth of cells in the
ectopic pregnancy (unlicensed use). As a
result the pregnancy shrinks and eventually
disappears. The advantage of methotrexate
is that it avoids the need for surgery but
success rates with methotrexate tend to be
slightly lower than with surgery.
Occasionally, both surgery and methotrexate
will be necessary.
What about future
pregnancies?

The outlook for future pregnancies depends

on several factors, especially whether the
other Fallopian tube appeared normal or not.

As a general guide, after one ectopic

pregnancy, 20 per cent of women will
experience another ectopic pregnancy, 30
per cent will not become pregnant again and
50 per cent will have a successful pregnancy
inside the womb.

Based on a text by Dr Charlotte Floridon,

specialist and Dr Niels Lund

Last updated 01.05.2008