Ectopic Pregnancy

🧭 When to suspect

An ectopic pregnancy is a pregnancy that implants outside the womb, most often in a fallopian tube. It affects around 11 in every 1,000 pregnancies in the UK and can be fatal if it ruptures, so the working rule in primary care is simple: any woman of reproductive age with pelvic or abdominal pain could be pregnant, and any pregnant woman with pain could have an ectopic.

Suspect it in a woman of childbearing age with lower abdominal or pelvic pain and/or vaginal bleeding – even when the bleeding looks like a period. The classic triad of missed period, pain and bleeding is helpful but unreliable: the period is not always missed, bleeding is often dark, scanty or watery, and the pain usually comes before or outweighs the bleeding. Presentation is frequently atypical, and ectopic readily mimics a tummy bug or a urine infection.

Risk factors raise suspicion but do not rule it out – about a third of women with an ectopic have no risk factor at all. The strongest are a previous ectopic, tubal damage (previous pelvic inflammatory disease, known as PID, or chlamydia; tubal or pelvic surgery; sterilisation), a contraceptive coil in place (an intrauterine device or system, IUD/IUS), conception by IVF (in vitro fertilisation, a form of assisted conception), and smoking.

Source: NICE NG126 · RCOG GTG 21