Understanding Ectopic Pregnancy
An ectopic pregnancy is one that implants outside the uterus, most often in a fallopian tube. The pregnancy cannot continue there, and if it is not diagnosed in time the tube can rupture and cause serious internal bleeding. It is one of the few genuine emergencies in early pregnancy.
The warning signs are one-sided lower abdominal pain, vaginal bleeding or spotting, and shoulder-tip pain, usually between the sixth and tenth week. The risk is higher after previous tubal surgery, previous ectopic pregnancy, pelvic infection, or conception with an intrauterine device in place. Diagnosed early, it can often be treated with medication alone.
Diagnosis and Treatment
Assessment is prompt, and treatment is chosen to preserve future fertility wherever it safely can be.
- Urgent assessment - clinical examination alongside a pregnancy test on the same visit.
- Transvaginal ultrasound - the key investigation for locating the pregnancy accurately.
- Serial beta hCG measurement - tracking the hormone pattern where the scan is not yet conclusive.
- Expectant management - close monitoring in carefully selected cases where the pregnancy is resolving on its own.
- Medical management - methotrexate for early, stable ectopic pregnancies, avoiding surgery altogether.
- Laparoscopic surgery - keyhole removal of the ectopic pregnancy, preserving the tube where that is possible.
- Emergency surgery - immediate operative management if rupture has occurred.
- Follow-up and future planning - hCG monitoring until it returns to zero, anti-D where required, and early scanning in the next pregnancy.
If you have a positive pregnancy test with one-sided abdominal pain, bleeding, dizziness or shoulder-tip pain, do not wait for your scheduled appointment. Contact us or attend the nearest emergency department immediately.
