Ectopic Pregnancy

Symptoms of ectopic pregnancy

At first, symptoms may look like a normal early pregnancy: a missed period, a positive pregnancy test, nausea or breast tenderness. Some women have no obvious symptoms and the diagnosis is raised during early ultrasound follow-up.

• Lower abdominal or pelvic pain, often more intense on one side.
• Vaginal bleeding or brown spotting different from a normal period.
• Shoulder tip pain, especially when combined with abdominal pain.
• Discomfort during urination or bowel movements.
• Dizziness, weakness, fainting tendency or pallor.

Symptoms of rupture and emergency care

Sudden severe abdominal pain, fainting, fast heartbeat, shortness of breath, confusion or signs of shock may indicate rupture and internal bleeding. This is an emergency and requires immediate hospital care.

Risk factors and clinical picture

The risk is higher after a previous ectopic pregnancy, tubal damage or surgery, pelvic inflammatory disease, assisted reproduction treatment and smoking. However, ectopic pregnancy can also occur without an obvious risk factor.

Recovery and next pregnancy

After treatment, instructions are individualized for recovery, sexual activity and when a new pregnancy can be attempted. In the next pregnancy, early contact with the obstetrician and early ultrasound are recommended to confirm that the pregnancy is inside the uterus.

Diagnosis with transvaginal ultrasound

Transvaginal ultrasound is central to diagnosis. The doctor checks whether a pregnancy sac is visible inside the uterus, whether there is a mass near the fallopian tube or ovary and whether there is free fluid in the pelvis. Very early in pregnancy, the location may not yet be clear.

Diagnosis with serial beta-hCG measurements

When the pregnancy location is unclear, repeat beta-hCG blood tests are performed, usually about 48 hours apart, together with repeat ultrasound. Beta-hCG is not used alone to define the pregnancy location; it is interpreted with symptoms and ultrasound findings.

Pregnancy of unknown location

Pregnancy of unknown location means the pregnancy test is positive but no pregnancy is yet seen inside or outside the uterus. It is not a final diagnosis. Careful follow-up is needed until an intrauterine pregnancy, miscarriage or ectopic pregnancy is confirmed.

Treatment with expectant management

In selected clinically stable women with minimal pain, a small ectopic pregnancy and low beta-hCG levels that are falling, close monitoring may be recommended. Follow-up continues until beta-hCG returns to non-pregnant levels, with clear instructions for urgent review if pain, bleeding or weakness appears.

Treatment with methotrexate

Methotrexate can be used in selected cases of unruptured ectopic pregnancy when the woman is stable, has no significant pain and can follow the monitoring schedule. A viable intrauterine pregnancy must be excluded before treatment. Beta-hCG is followed carefully afterward and some cases need an additional dose or surgery.

Surgical treatment

Surgery is needed when rupture is suspected, pain is significant or persistent, the woman is unstable, beta-hCG is high, the ectopic pregnancy is large, fetal cardiac activity is seen outside the uterus or safe follow-up is not possible. Treatment is usually laparoscopic. Depending on the tube and future fertility plans, the affected tube may be removed or conservative surgery may be considered.