Ectopic Pregnancy

Ectopic pregnancy is when a fertilised egg implants outside the uterus — most often in a fallopian tube. It cannot develop normally and can cause the tube to rupture, leading to dangerous internal bleeding. Ectopic pregnancy is a medical emergency and one of the commonest causes of maternal death in the first trimester in India.

Red flags — dial 112 immediately

• One-sided severe lower-belly pain with a positive pregnancy test, missed or abnormal period.
• Vaginal bleeding or spotting in early pregnancy.
• Shoulder-tip pain (blood in the abdomen irritating the diaphragm).
• Fainting, dizziness, rapid heartbeat, pale/sweaty — bleeding inside the abdomen; surgical emergency.

Who is at higher risk

• Previous ectopic pregnancy.
• History of pelvic inflammatory disease (Chlamydia, gonorrhoea), genital TB — damaged tubes.
• Previous tubal surgery or sterilisation.
• IUD in place (overall rates are low, but if pregnancy does happen, it's more likely ectopic).
• Infertility treatment — slightly higher rate.
• Smoking.
• Any woman with a positive pregnancy test and new pelvic pain or bleeding — keep ectopic on the list.

Diagnosis

• Pregnancy test (beta-hCG) — may be lower-than-expected for dates.
• Transvaginal ultrasound — looks for pregnancy in the uterus; empty uterus with positive test raises concern.
• Serial hCG — slower rise than a normal pregnancy.
• Sometimes laparoscopy for definitive diagnosis.

Treatment

• Medical — a specific medicine injection if caught early, the ectopic is small, stable, and beta-hCG is low. Avoids surgery.
• Surgical — laparoscopy or open surgery, to remove the ectopic tissue; fallopian tube preserved where possible. Emergency surgery if rupture/bleeding.
• Anti-D injection if Rh-negative.

After an ectopic pregnancy

• Most women can have a healthy pregnancy afterward.
• Higher risk of another ectopic — early scan in the next pregnancy confirms the location.
• Grief is real — an ectopic pregnancy is still a pregnancy loss.
• Address any infection risk factors; treat partners for STIs where relevant.