Ectopic pregnancy and pregnancy of unknown location: signs, scans and treatment

Few things are as frightening as being told your pregnancy may not be in the right place, or that nobody can see it yet. Here’s what both situations mean, the symptoms that need urgent help, and what happens next.

What is an ectopic pregnancy?

An ectopic pregnancy is when a fertilised egg implants outside the womb, usually in one of the fallopian tubes. An ectopic pregnancy can’t continue and usually needs medicine or surgery. About 1 in 90 pregnancies in the UK are ectopic.

Symptoms

The NHS says symptoms tend to develop between weeks 4 and 12, though some people have none and it’s found on a routine scan. Possible signs are:

a missed period
tummy pain, usually low down on one side
vaginal bleeding or brown discharge
pain in the tip of your shoulder
discomfort when passing urine or stools

These can also be caused by less serious things, but they should always be checked.

When to get help

If you’re pregnant, or think you could be, and you have a combination of symptoms such as tummy pain low down on one side, vaginal bleeding or brown watery discharge, pain in the tip of your shoulder, or discomfort when you pee or poo, contact your GP or call NHS 111 straight away, even if you haven’t had a positive pregnancy test. An early pregnancy unit or your maternity unit can also advise.

Call 999 or go to A&E immediately if you have sudden, sharp, intense tummy pain and feel very dizzy or faint, feel sick, or look very pale. These can be signs that a fallopian tube has split open (ruptured). The NHS miscarriage page also advises urgent help for heavy bleeding.

Who is more likely to have one?

Often the cause isn’t clear. The NHS says risks include pelvic inflammatory disease, a previous ectopic pregnancy, previous fallopian tube surgery, fertility treatment such as IVF, getting pregnant while using a coil (IUD or IUS), smoking, and being over 35. You can have an ectopic pregnancy without any of these. See getting pregnant on the coil, implant or pill.

What is a pregnancy of unknown location?

A pregnancy of unknown location (PUL) is when your pregnancy test is positive but the pregnancy can’t yet be seen on an ultrasound scan. One hospital’s patient information describes it as a medical label rather than a diagnosis, used until the outcome is known. It may be too early to see the pregnancy. The pregnancy may have ended already, since a urine test can stay positive for up to three weeks after a loss. Or it could be an ectopic pregnancy, which can be harder to see. The outcome may be a healthy pregnancy, a miscarriage or an ectopic pregnancy.

You’ll usually have blood tests to measure your pregnancy hormones, often repeated after about two days, and repeat scans. Timing depends on your results and your unit. Until you have an answer, go to hospital immediately if you get worsening tummy pain, shoulder pain or fainting. See early pregnancy scans before 12 weeks.

How ectopic pregnancy is treated

Watchful waiting: you’re monitored, and another treatment is used if the pregnancy doesn’t resolve on its own.
Medicine: a methotrexate injection stops the pregnancy growing.
Surgery: keyhole surgery under general anaesthetic, usually removing the affected tube.

The NHS says an anti-D injection is usually offered if you’re 12 weeks pregnant or more, your blood group is rhesus negative, and you’re having treatment. See rhesus negative and anti-D.

Afterwards

It’s common to feel shock, grief or anxiety, and the NHS says these feelings can last for several months. Your GP can arrange counselling. The NHS lists the Ectopic Pregnancy Trust, Miscarriage UK and Cruse Bereavement Care as places to get support. Most people can get pregnant again, even after losing a tube. You will probably be advised to wait at least 2 periods after treatment, and at least 3 months after methotrexate. Tell your GP early if you become pregnant again. See trying again after a miscarriage.

Questions people ask

Can an ectopic pregnancy be moved to the womb?

No. An ectopic pregnancy can’t continue and usually needs medicine or surgery.

Can I have an ectopic pregnancy and still get a positive test?

Yes. The NHS says to contact your GP or NHS 111 if you have the symptoms and might be pregnant, even without a positive test.

Is a pregnancy of unknown location bad news?

Not necessarily. It means the answer isn’t clear yet. The outcome can be a healthy pregnancy, a miscarriage or an ectopic pregnancy, and follow-up tests will usually sort out which.

Will I be able to get pregnant again?

Most people can, even after tube removal, though sometimes IVF is needed. The NHS says the chance of another ectopic pregnancy is higher but still small.