An ectopic pregnancy is when the embryo implants itself outside of the uterine cavity; almost all ectopic pregnancies result in miscarriages. In about 95% of ectopic pregnancies, the egg settles in the fallopian tubes, but it can also implant in the ovary, the abdomen or the cervix. None of these areas has as much space or nurturing tissue as a uterus for a baby to develop. As the foetus grows, it will most likely rupture the organ that contains it. This can cause severe bleeding and endanger the mother’s life and it happens in about 1% of all pregnancies.

Signs of an ectopic pregnancy

Many ectopic pregnancies go undiagnosed until it’s too late and presents a danger to the new mum. They most commonly occur between the fourth and twelfth week of pregnancy. They are difficult to diagnose as they often present signs that are associated with an oncoming period (missed period) or a possible miscarriage (lower abdominal pain and vaginal bleeding). Here are some of the most noticeable signs of an ectopic pregnancy:

  • Unusual vaginal bleeding – bleeding that is different from your period, in that it is either heavier or lighter than usual, with a darker colour and more watery composition.
  • Pain – Discomfort or soreness in one side of the lower abdomen that intensifies while going to the toilet
  • If the fallopian tube ruptures, rapid onset of severe pain in the lower abdomen and pain in the shoulder
  • · Shoulder tip pain - felt where your shoulder ends and your arm begins. It is not known exactly why shoulder tip pain occurs, but it usually occurs when you are lying down and is a sign that the ectopic pregnancy is causing internal bleeding. The bleeding is thought to irritate the phrenic nerve, which is found in your diaphragm (the muscle used during breathing that separates your chest cavity from your abdomen). The irritation to the phrenic nerve causes referred pain (pain that is felt elsewhere) in the shoulder blade.
  • Generally you should be aware of these symptoms if you are in a high risk group, these groups include women who:

    • Have previously been diagnosed with Chlamydia
    • Have had previous abdominal surgery or caesarean sectors
    • Become pregnant through IVF
    • Have had previous ectopic pregnancies
    • Have damage to the fallopian tubes due to a ruptured appendix

    To confirm the diagnosis a pelvic or vaginal ultrasound with a blood test will usually be carried out. It is important to tell your doctor if your medical history includes any of the known risk factors. You should also see your doctor immediately if you experience unusual pregnancy symptoms such as cramping, pain or vaginal bleeding. An ectopic pregnancy cannot normally survive as it does not receive enough blood supply and nutrition, so they are either removed using a Laparoscopy (keyhole surgery) or are treated with Methotrexate, which will stop the growth of the embryo.

    Future Ectopic pregnancies

    Some women who have had ectopic pregnancies will have difficulty becoming pregnant again. This difficulty is more common in women who also had fertility problems before the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of the damage that was done.

    The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another. If one of the tubes ruptured or was badly damaged, your chances of conceiving again are reduced. There is little you can do to prevent an ectopic pregnancy from happening in the future, although if your ectopic has been caused by a current Chlamydia infection you can have a course of antibiotics to clear it up and reduce further damage to your tubes.

    Ectopic pregnancies can be very scary, but knowing the facts can help you spot a problem early on in the pregnancy before it becomes life threatening. Remember to report any problems to your doctor right away and remember that there are effective treatments available if you do have this type of a pregnancy.


    For more information and support, see your General Practitioner, midwife or health care professional. You can also visit http://cope.org.au or http://www.sands.org.au, or call the SANDS helpline on 1300 072 637.