Symptoms of ectopic pregnancy

Lower tummy pain and/or bleeding experiences by some pregnant women may be due to many things. They could, however, be due to an ectopic pregnancy. If you are experiencing any of the following ectopic pregnancy symptoms, please call the NHS Direct 111 service by dialling 111, contact your out of hours GP service or your normal surgery, or visit your local Accident and Emergency department (A&E).

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Diagnosis of ectopic pregnancy may sometimes be difficult, and symptoms may occur from as early as 4 weeks pregnant and up to 12 weeks or even later. In addition, although there are a number of recognised risk factors (e.g. smoking, sexually transmitted infections, history of previous ectopic pregnancy, fertility treatment e.g. IVF); in over 50% of women diagnosed with and ectopic pregnancy, there are no identifiable risk factors.

Not all women experience symptoms. Some women experience symptoms that are also similar to other ailments such as gastroenteritis (tummy bug) and miscarriage, which are the most common ways to misdiagnose an ectopic pregnancy. Please do be vigilant and take pain that concerns you seriously until absolutely proven otherwise. If your instincts are screaming at you that something doesn’t feel right, it’s OK to trust them and ask for a reassessment at any time.

Please click on the list of symptoms and they will open out if you need any more detail:

A missed or late period

A missed or late period

If you have missed one or more periods, the most likely reason is that you have a normal pregnancy. However, the fact that you may experience normal pregnancy symptoms, such as nausea, painful breasts or a swollen abdomen but no bleeding or pain, does not completely rule out an ectopic pregnancy, although this is rare.

Pregnancy Test

Pregnancy Test

This is normally positive, however can very rarely come up with a negative result on a urine pregnancy test.  Specialised hCG blood tests performed by your doctor are sometimes required to confirm this. Human Chorionic Gonadotropin (hCG) is a hormone produced by a fertilised egg after conception. The hormone is most commonly detected in urine by using a pregnancy test, where it can be positive or negative. Blood tests can tell you the exact value of the hCG level in the blood, which can help with planning of the care you receive and treatment. However, an internal ultrasound scan is the best way to diagnose and ectopic pregnancy (see diagnosis)

Abdominal Pain

Abdominal Pain

  • One-sided pain in your tummy
  • This can be persistent and severe or intermittent, which means it can come and go
  • The pain may have begun suddenly or gradually
Abnormal bleeding

Abnormal bleeding

  • Bleeding is often dark and ‘prune juice’ like (i.e. a brownish colour)
  • Some women do report spotting and bleeding of redder blood

If you don’t know whether you are pregnant but find yourself having an unusual period, it may be due to a number of causes, one of which might be an ectopic pregnancy, particularly if you have had a coil (IUCD) fitted. If your bleeding is heavier or lighter than usual and prolonged or if, unlike your normal monthly period, this bleeding is slight, dark and watery, you should tell your doctor as soon as possible.

You should be aware of any change in the bleeding you are experiencing.  If it becomes very heavy, causing you to soak a pad in less than an hour, or if you soak a pad in two hours with this level of flow continuing for more than 4 hours, you should have this checked out.

Bleeding in early pregnancy is thought to occur in about 30% of all pregnancies, of which only 1 to 2% will be ectopic.

Shoulder tip pain

Shoulder tip pain

  • The pain may have begun suddenly
  • It tends to develop after you have been aware of feeling unwell or having other symptoms of vaginal bleeding and pain

It is caused by internal bleeding irritating the diaphragm (the muscle in your chest which helps you to breathe) when you breathe in and out. Shoulder tip pain is exactly where it says – not the neck or the back but the tip of your shoulder. If you look to the left over your shoulder and then cast your eyes down, the tip of your shoulder is where your shoulder ends and your arm starts.

Shoulders cause pain when we are stressed because we hold ourselves more rigidly and muscles in the back and neck go in to spasm – this is not shoulder tip pain; Shoulder tip pain is very distinctive. You know when you have it because it is a very ‘weird’ pain you have probably never experienced before.

Bladder or Bowel Problems

Bladder or Bowel Problems

  • Diarrhoea
  • Pain when you have your bowels open (go for a poo)
  • Pain when you pass water (have a wee)

Some pain and a change in your normal bladder and bowel pattern are features of a normal pregnancy for some women. All the same, if you present at your GP or Hospital Pregnancy Unit with such symptoms, it would be reasonable to have an early pregnancy assessment.

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  • Feeling light-headed or faint, or actually fainting
  • Often accompanied by sickness and looking pale
  • Increasing pulse rate or falling blood pressure may also be present

If you experience these symptoms, it is important to seek urgent medical attention.

Deciding whether your symptoms are getting worse

Trying to decide whether your symptoms are getting worse can be really tricky but, as a general rule, if you aren’t sure something is wrong then you are probably OK to wait for half an hour and continue to make your own assessment. The difficulty is, often when we feel worried about our pregnancy, when no one can be precise about a diagnosis and there isn’t a doctor on hand to ask, stress can, naturally, cause us to become very concerned and confused.

If you have concerns, it is best to try and seek medical attention for some advice. Your GP will likely refer you to your local early pregnancy unit for an assessment and an ultrasound scan.

When considering pain, it can be helpful to give yourself a pain scale, with zero being no pain at all and ten being the worst pain you have ever had in your life multiplied by ten. If the pain is severe and worsening, you must seek urgent medical attention.

It is important to remember that pregnancy symptoms are very common, and that not all women experiencing such symptoms have an ectopic pregnancy as it is rare (incidence 1.14% in the UK). However, it is important to be vigilant and if in doubt seek medical attention.