Twenty-eight-year-old Anjali, a sales executive in Kochi, thought she was simply exhausted from working long hours. She had missed a period, felt occasional abdominal discomfort, and noticed some light spotting.
Assuming it was stress, she ignored the symptoms and continued with her busy schedule. One evening, however, severe pain struck suddenly. She became dizzy and collapsed. In the emergency department, doctors diagnosed an ectopic pregnancy that had ruptured, causing internal bleeding. Emergency surgery saved her life.
Anjali's story is not uncommon. Many women have never heard of ectopic pregnancy until it affects them or someone they know. Yet recognising the warning signs early can make the difference between a straightforward treatment and a life-threatening emergency.
When pregnancy grows in the wrong place
In a normal pregnancy, a fertilised egg travels through the fallopian tube and settles inside the uterus, where the baby grows and develops. An ectopic pregnancy occurs when the fertilised egg implants outside the uterus.
About one in every 90 pregnancies is ectopic. While uncommon, it is one of the most serious complications of early pregnancy. Most ectopic pregnancies occur in the fallopian tube, which connects the ovary to the uterus. More rarely, they may develop in the ovary, cervix, abdominal cavity, or elsewhere in the pelvis.
Sadly, an ectopic pregnancy cannot develop into a healthy baby. More importantly, as the pregnancy grows, it can stretch and eventually rupture the surrounding tissue, leading to severe internal bleeding. Without prompt medical care, the condition can become life-threatening.
The uncertainty of a pregnancy of unknown location
Sometimes a woman has a positive pregnancy test, but the pregnancy cannot be seen on an ultrasound scan. Doctors call this a Pregnancy of Unknown Location (PUL).
This can happen for several reasons. The pregnancy may simply be too early to see on a scan. The woman may have already experienced a miscarriage, while the pregnancy hormone remains detectable. Alternatively, the pregnancy may be ectopic.
For many couples, this period of uncertainty can be emotionally draining. Repeated blood tests and follow-up scans are often needed before doctors can determine exactly what is happening. Patience is important because making the correct diagnosis guides the safest treatment.
Symptoms you should never ignore
One of the challenges of diagnosing ectopic pregnancy is that symptoms vary greatly. Some women have no symptoms at all, while others become seriously ill.
Symptoms commonly appear between six and ten weeks of pregnancy, often around two weeks after a missed period.
Warning signs include:
- Pain in the lower abdomen, particularly on one side
- Vaginal bleeding or spotting that differs from a normal period
- Shoulder tip pain, caused by irritation from internal bleeding
- Discomfort during bowel movements
- Dizziness, fainting or collapse
- Sudden severe abdominal pain
Many women are unaware they are pregnant when these symptoms appear, especially if their menstrual cycles are irregular or contraception has failed.
Shoulder tip pain deserves special attention. It may seem unrelated to pregnancy, yet it is a classic sign that blood is collecting inside the abdomen and irritating the diaphragm. Women experiencing shoulder tip pain together with a positive pregnancy test or missed period should seek urgent medical assessment.
When should you seek help?
The simple answer is: immediately.
If you have been sexually active in the previous few months and develop abdominal pain, unusual bleeding or any of the symptoms described above, do not wait for them to settle on their own.
Even women using contraception can become pregnant. Assuming "it can't be pregnancy" is a dangerous gamble. Emergency medical attention is especially important if severe pain, dizziness, fainting or collapse occurs.
Who is more likely to have an ectopic pregnancy?
An ectopic pregnancy can occur in any woman of reproductive age, but certain factors increase the risk.
Women are more likely to experience an ectopic pregnancy if they have:
- Had a previous ectopic pregnancy
- A previous infection affecting the fallopian tubes
- Surgery involving the fallopian tubes, including sterilisation procedures
- Conceived through IVF or other assisted reproductive techniques
- Become pregnant while using an intrauterine device (IUD)
- Becoming pregnant while taking the progesterone-only pill
- A history of smoking
These factors do not mean an ectopic pregnancy will occur, but they warrant extra vigilance in early pregnancy.
How doctors make the diagnosis
Diagnosing an ectopic pregnancy is sometimes straightforward, but often requires careful monitoring.
The first step is usually a pregnancy test. Ultrasound scanning, particularly a transvaginal ultrasound, helps doctors identify where the pregnancy is located.
Blood tests measuring the pregnancy hormone beta-hCG also play a crucial role. In a healthy pregnancy inside the uterus, hormone levels usually rise rapidly. In many ectopic pregnancies, the rise is slower or abnormal.
When scan findings and blood results remain unclear, repeated testing over several days may be necessary. In rare situations, keyhole surgery (laparoscopy) is performed to confirm the diagnosis and treat the condition at the same time.
Treatment: Not one size fits all
Because an ectopic pregnancy cannot continue safely, treatment is always required. The best option depends on the woman's symptoms, hormone levels, scan findings and future fertility plans.
Watchful waiting
Some very early ectopic pregnancies resolve naturally without intervention. In carefully selected women, doctors may recommend close monitoring through repeated blood tests until pregnancy hormone levels return to normal. However, this approach requires reliability and rapid access to medical care should symptoms worsen.
Medication
Methotrexate is a medicine that stops pregnancy tissue from growing.
Given as an injection, it allows the body to gradually absorb the ectopic pregnancy without surgery. Most women require only one dose, although some may need a second injection. Regular follow-up is essential, and women are advised not to become pregnant for at least three months after treatment.
Surgery
Surgery may be required if symptoms are severe, hormone levels are high, medication is unsuitable, or the ectopic pregnancy has ruptured.
Most operations are performed using keyhole surgery, allowing a faster recovery. Occasionally, open surgery is necessary, particularly when heavy internal bleeding has occurred. The surgeon may remove the affected fallopian tube or, in selected cases, preserve it while removing the pregnancy.
The emotional impact is often overlooked
Much of the medical discussion focuses on scans, blood tests and surgery. Yet the emotional toll can be equally significant. Women may be grieving the loss of a wanted pregnancy while simultaneously coping with a frightening medical emergency. Some struggle with concerns about future fertility. Partners and family members are often deeply affected as well. Recovery is therefore not only physical but emotional. Seeking support from healthcare professionals, family members or counsellors can be invaluable.
Can you have a normal pregnancy afterwards?
The encouraging news is that most women go on to have successful pregnancies after an ectopic pregnancy. Even with one remaining fallopian tube, fertility is often preserved. Although the risk of another ectopic pregnancy increases to around 7-10 per cent, the majority of future pregnancies develop normally inside the uterus.
Women who have previously experienced an ectopic pregnancy should contact their doctor as soon as they have a positive pregnancy test. An early ultrasound scan at six to eight weeks can confirm that the pregnancy is developing in the right place.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
