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Conditions · Pelvis

Ectopic pregnancy !

An ectopic pregnancy implants outside the uterus, usually in a uterine tube; it cannot continue, and if the tube ruptures it bleeds and is an emergency.

Updated 2026-10-29

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What it is

A pregnancy that implants outside the uterine cavity, most often in the ampulla of the uterine tube. It cannot continue normally, and a ruptured ectopic pregnancy is a surgical emergency.

Who gets it

A leading cause of first-trimester maternal death worldwide, mostly from haemorrhage after rupture. It is a must-exclude diagnosis in any woman of reproductive age with abdominal pain or bleeding and a positive pregnancy test, in Colombia as elsewhere.

Causes

  • Tubal damage that slows transport of the embryo to the uterus
  • Previous pelvic infection (for example chlamydia or gonorrhoea) scarring the tube
  • Most occur in the tube (ampulla most common, then isthmus and fimbriae); rarer sites are the interstitial (cornual) tube, cervix, ovary, a caesarean scar and the abdomen

Risk factors

  • Previous ectopic pregnancy
  • Pelvic inflammatory disease or sexually transmitted infections
  • Previous tubal surgery, including tubal ligation
  • Pregnancy with an intrauterine device in place
  • Assisted reproduction
  • Smoking

Pathophysiology

Damage to the tubal lining and its cilia delays the embryo, which implants in the tube wall. The tube cannot stretch like the uterus, so the growing trophoblast erodes the wall and its vessels. This can end in tubal abortion, spontaneous resolution or rupture with bleeding into the peritoneal cavity.

Classification

  • By site: tubal (ampullary, isthmic, fimbrial, interstitial), cervical, ovarian, caesarean scar, abdominal
  • Unruptured or ruptured
  • Heterotopic pregnancy: an intrauterine and an ectopic pregnancy at the same time (rare, more often after assisted reproduction)
  • Pregnancy of unknown location: positive test with no pregnancy seen on ultrasound yet (a working label, not a diagnosis)

Symptoms and signs

  • Missed period or amenorrhoea of some weeks
  • Lower abdominal or pelvic pain, often one-sided
  • Vaginal bleeding or spotting
  • Adnexal or cervical motion tenderness on examination
  • Shoulder-tip pain from blood irritating the diaphragm

Diagnosis

Clinical
Any woman of reproductive age with pain or bleeding needs a pregnancy test. Haemodynamic status is assessed first, because a ruptured ectopic pregnancy needs surgery before further tests.
Tests
Quantitative serum beta-hCG, repeated after about 48 hours when the location is unclear; an abnormal rise suggests a non-viable or ectopic pregnancy. Blood group and Rh, full blood count.
Imaging
Transvaginal ultrasound: no intrauterine pregnancy with an adnexal mass, an extrauterine gestational sac or free fluid. The hCG level above which an intrauterine sac should be seen varies between guidelines.

Differential diagnosis

  • Miscarriage (threatened or incomplete)
  • Ruptured corpus luteum cyst
  • Ovarian torsion
  • Pelvic inflammatory disease
  • Acute appendicitis
  • Pyelonephritis or kidney stones

Goal of treatment

Prevent or control haemorrhage, remove or stop the ectopic pregnancy, and preserve future fertility where possible.

Treatment

Acute
Ruptured or unstable: resuscitation with fluids and blood and emergency surgery.
Medical
Methotrexate (a folate antagonist) for selected stable, unruptured cases with low hCG, with serial hCG until negative; it needs reliable follow-up.
Surgical
Laparoscopic salpingectomy (removing the tube) or salpingostomy (opening it to remove the pregnancy); laparotomy when unstable or laparoscopy is not possible.
Follow-up
Expectant management with serial hCG for selected stable women whose hCG is low and falling.
Medical
Anti-D immunoglobulin for Rh-negative women, according to local guidelines.

Drugs for this condition

Complications

  • Tubal rupture and haemoperitoneum
  • Hypovolaemic shock and maternal death
  • Persistent trophoblast after salpingostomy
  • Recurrence in a later pregnancy
  • Reduced fertility

Prognosis

With early diagnosis most women are treated before rupture and recover fully. Many later have an intrauterine pregnancy, although the risk of another ectopic pregnancy is higher than in the general population.

Prevention

  • Prevention and early treatment of sexually transmitted infections
  • Early ultrasound in later pregnancies for women with a previous ectopic pregnancy
  • Not smoking

Test yourself

Think of the answer, then tap the question to see it.

What is the most common site of an ectopic pregnancy?

The uterine tube, most often its ampulla.

Which two tests together usually make the diagnosis in a stable patient?

Quantitative serum beta-hCG (often serial) and transvaginal ultrasound.

What is the first step for a woman with a positive pregnancy test, pelvic pain and hypotension?

Resuscitation and emergency surgery for a presumed ruptured ectopic pregnancy.

Which drug is used for medical treatment of selected unruptured ectopic pregnancies?

Methotrexate, a folate antagonist, with serial hCG until it is negative.

What is a major risk factor for ectopic pregnancy?

Previous ectopic pregnancy, pelvic inflammatory disease, tubal surgery, assisted reproduction or pregnancy with an IUD in place.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Ectopic Pregnancy (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

Ampulla of uterine tube highlighted on the Durgical 3D model