Ectopic Pregnancy: Symptoms, Diagnosis and Treatment
What an ectopic pregnancy is and which symptoms are urgent; diagnosis with beta-hCG and ultrasound, methotrexate, laparoscopic surgery and future fertility.
Op. Dr. Sadık Kükrer, MD
Obstetrician & Gynecologist · Adana, Türkiye
An ectopic pregnancy is one that implants outside the uterine cavity, most often in a fallopian tube. It occurs in about 1–2% of pregnancies and is the leading cause of life-threatening bleeding in the first trimester. When diagnosed early it can usually be treated safely with medication or keyhole surgery, frequently preserving the tube.
Emergency symptoms
If your pregnancy test is positive or your period is late, attend the emergency department without delay if you experience any of the following:
- Severe or increasing pelvic pain, often on one side
- Dizziness, faintness or cold sweats
- Shoulder-tip pain (caused by internal bleeding)
- A sensation of rectal pressure
- Heavy vaginal bleeding
Risk factors
- A previous ectopic pregnancy
- Tubal surgery or sterilisation
- Previous pelvic infection, particularly chlamydia
- Endometriosis
- IVF and other assisted reproduction
- Smoking
- Conceiving with an intrauterine device in place
Diagnosis
Diagnosis is based on serial serum beta-hCG measurements 48 hours apart and transvaginal ultrasound. In a normal pregnancy beta-hCG rises at a predictable rate, and above a certain level a gestational sac should be visible in the uterus. The absence of an intrauterine sac, an adnexal mass or free pelvic fluid suggests an ectopic pregnancy. Where the location cannot be determined, close follow-up continues. See also pregnancy testing and bleeding in pregnancy.
Treatment options
- Expectant management: for selected women without symptoms whose beta-hCG is low and falling spontaneously.
- Methotrexate: tube-preserving medical treatment for stable women with a small mass and no signs of bleeding; follow-up continues until beta-hCG is negative.
- Laparoscopic surgery: for internal bleeding, suspected rupture, high beta-hCG or failed medical treatment; the pregnancy tissue or the tube is removed. Laparoscopy allows rapid recovery.
After treatment
Rh-negative women receive anti-D immunoglobulin. After methotrexate, waiting at least three months before trying to conceive is usually advised. In any future pregnancy an early ultrasound should confirm intrauterine implantation as soon as the test is positive. The emotional impact of pregnancy loss should not be underestimated, and support should be sought where needed.
Op. Dr. Sadık Kükrer, MD diagnoses and treats ectopic pregnancy, including medical management and laparoscopic surgery, in Adana, Türkiye.
Frequently asked questions
What is an ectopic pregnancy?+
It is implantation of a fertilised egg outside the lining of the uterus, in the great majority of cases in a fallopian tube. Less commonly it occurs in the ovary, cervix, a caesarean scar or the abdominal cavity. Such pregnancies cannot develop normally and, if untreated, the tube may rupture and cause internal bleeding.
What are the symptoms?+
One-sided or generalised pelvic pain with spotting or light bleeding after a missed period or a positive test are the commonest symptoms. Severe abdominal pain, dizziness, fainting, shoulder-tip pain and a sensation of rectal pressure suggest internal bleeding and require emergency care.
Who is at risk?+
Risk is increased by a previous ectopic pregnancy, tubal surgery or sterilisation, previous pelvic infection (particularly chlamydia), endometriosis, IVF, smoking and conceiving with an intrauterine device in place. However, about half of women with an ectopic pregnancy have no identifiable risk factor.
How is it diagnosed?+
Serum beta-hCG is measured and repeated after 48 hours. On transvaginal ultrasound, the absence of an intrauterine gestational sac, an adnexal mass or free fluid in the pelvis supports the diagnosis. Several measurements may be needed; in the meantime the pregnancy is managed as a 'pregnancy of unknown location' with close follow-up.
Who is suitable for methotrexate?+
Women who are haemodynamically stable, show no signs of internal bleeding, have relatively low beta-hCG and a small mass on ultrasound may be treated with a methotrexate injection, preserving the tube. Beta-hCG is monitored until it is negative; alcohol, folic acid-containing supplements and intercourse are avoided during this period.
When is surgery needed?+
Laparoscopic surgery is performed for internal bleeding, suspected rupture, high beta-hCG, a visible fetal heartbeat or failure of medical treatment. Depending on the tube, either the pregnancy tissue is removed (salpingotomy) or the tube is removed (salpingectomy).
Can I get pregnant again after an ectopic pregnancy?+
Yes. Most women who lose one tube conceive naturally through the other. Because the risk of recurrence is somewhat higher, an early ultrasound should confirm the location of any future pregnancy as soon as the test is positive.
Would you like to book a consultation?
For pregnancy monitoring, women's health, and gynecologic surgery in Adana, get in touch with Op. Dr. Sadık Kükrer.
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