Ectopic Pregnancy

An ectopic pregnancy occurs when a fertilised egg implants outside the uterus, most commonly in a fallopian tube. It cannot develop safely outside the uterus and is a life-threatening emergency if it ruptures, causing severe internal bleeding.

• Missed period with a positive pregnancy test
• Lower abdominal or pelvic pain, often on one side
• Vaginal bleeding, which may be light and different from a normal period
• Shoulder-tip pain, dizziness, or fainting can indicate internal bleeding from rupture — a medical emergency
• Signs of shock (rapid heart rate, low blood pressure, pallor) if significant internal bleeding has occurred

• Occurs when a fertilised egg implants and begins to grow outside the uterine cavity, most often in a fallopian tube.
• Risk is increased by previous pelvic infection or surgery, prior ectopic pregnancy, use of an intrauterine device at the time of conception, and prior fallopian tube damage.

• Suspected in any woman of reproductive age with a positive pregnancy test together with abdominal pain and/or vaginal bleeding.
• Ultrasound is used to confirm whether the pregnancy is inside or outside the uterus.
• Blood tests, including serial measurement of the pregnancy hormone (beta-hCG), can help support the diagnosis when ultrasound findings are unclear.
• Any woman with these symptoms and signs of shock should be treated as a medical emergency without delay for further testing.

A woman with a suspected ruptured ectopic pregnancy and signs of shock needs immediate resuscitation with intravenous fluids and urgent transfer for emergency surgery, as this is a life-threatening emergency.

Surgical removal of the ectopic pregnancy, usually through removal or repair of the affected fallopian tube, is the standard treatment where rupture has occurred or the pregnancy is advanced.

In selected early, unruptured cases identified through careful monitoring at a specialist facility, medical treatment with methotrexate may be considered as an alternative to surgery.

Any woman of reproductive age with abdominal pain, vaginal bleeding, and a positive pregnancy test should be referred urgently for assessment, as ectopic pregnancy must be excluded.

• Seek prompt treatment for pelvic infections to reduce the risk of tubal damage.
• Seek early antenatal care as soon as pregnancy is suspected, so that pregnancy location can be confirmed.
• Women with a previous ectopic pregnancy should seek early ultrasound assessment in future pregnancies.
• Seek immediate care for abdominal pain or bleeding in early pregnancy rather than waiting.