The first trimester of pregnancy is the most crucial time since the fertilized cell is growing and developing rapidly. What happens, however, when the fetus inside of you isn’t growing in the correct place? Instead of being in your uterus, it’s in your fallopian tube, cervix, ovary, or abdominal cavity. This is known as an ectopic pregnancy.

While it occurs in 20 out of 1,000 pregnancies in the U.S., it is detrimental to moms and has to be removed. To help you identify if you have an ectopic pregnancy, we’ve laid out ectopic pregnancy symptoms, common pain experienced, causes, risk factors, and treatment options.

Ectopic Pregnancy: What It is and What to Look Out For

What is an ectopic pregnancy?

In a normal pregnancy, a fertilized egg travels to the uterus and attaches itself to the uterine lining. On the other hand, an ectopic pregnancy occurs when the egg implants outside the uterus, such as in the abdominal cavity, cervix, or ovary. Often, ectopic pregnancies occur in the fallopian tubes, which has given way to the common moniker “tubal pregnancy.”

While ectopic pregnancies happen within the first few weeks of pregnancy, it is life-threatening for moms and must be removed. The fertilized egg cannot properly develop and, if it continues to grow in the incorrect area, can cause internal bleeding. It can also burst or rupture the organ to which it’s affixed.

What causes an ectopic pregnancy?

Risk factors for ectopic pregnancy include prior ectopic pregnancy, prior damage to the fallopian tubes, pelvic infection (such as PID), prior pelvic or fallopian tube surgery, history of infertility, and use of assisted reproductive technology. Other less significant risk factors include a history of cigarette smoking and an age older than 35. Since most ectopic pregnancies are tubal, the likely cause is issues in the fallopian tube.

During a tubal pregnancy, the fertilized egg cannot quickly move down the fallopian tube into the uterus and gets stuck along the way. Typically, this happens if the fallopian tube is damaged from either an infection or inflammation, but some other factors that can cause a blockage are:

• Endometriosis: a condition that occurs when the tissue from the uterus grows outside of it
• Pelvic inflammatory disease (PID)
• Scar tissue from a previous surgery in the abdominal, fallopian tube, or pelvis

How common is an ectopic pregnancy?

According to the American College of Obstetrics and Gynecology, about one in 50 pregnancies are ectopic, with over 90% occurring in the fallopian tubes.

Although any woman can experience an ectopic pregnancy, some are more at risk if they are older than 35 years old, smoke cigarettes, have a sexually transmitted infection, or have undergone (or are undergoing) fertility treatments.

Specific medical conditions can also increase the chance of having an ectopic pregnancy. These include having a scar from pelvic surgery or suffering from PID, a former ectopic pregnancy, or tubal litigation surgery, which closes the fallopian tubes to prevent future pregnancies. However, women who’ve had one should not lose hope, as there is a silver lining. About one in three women will go on to have a baby after an ectopic pregnancy.

Signs of Ectopic Pregnancy

At first, women may not notice any alarming signs of an ectopic pregnancy. Often, they’ll feel all the usual signs and symptoms that happen early on in a pregnancy, like breast tenderness, fatigue, frequent urination, missed menstrual cycles, morning sickness, or nausea. Even a pregnancy test can come out with a positive result.

The initial warning signs that can alert moms that something is wrong are light bleeding that is not associated with their period and pain in the pelvic region.

Common Symptoms

Various symptoms can alert women of an ectopic pregnancy, such as:

• Abdominal pressure that occurs on one side of the body
• Dizziness or fainting
• Vaginal bleeding or spotting (light or heavy)
• Low blood pressure, as a result of blood loss
• Sharp pains in your abdomen, neck, shoulder, pelvis, or rectum
• Upset stomach and vomiting
• Weakness

While most are detected before they can rupture, women should seek medical attention and contact their health professional immediately if they notice any of the mentioned symptoms.

Does ectopic pregnancy cause pain?

Ectopic pregnancy pain can range from lower backaches to mild or intense pain in the abdomen, pelvis, or rectum. There may also be discomfort in the shoulder or neck, which results from blood that builds up in the abdomen and irritated nerves due to a ruptured ectopic pregnancy.

Belly pain is also common and usually occurs in one area. It can come on suddenly or gradually develop and can last for a while or come and go.

When does ectopic pregnancy pain start?

Those suffering from an ectopic pregnancy can develop symptoms anywhere from the 4th to the 12th week of pregnancy. Though, this is not the same for everyone. Some women do not feel any early signs and may discover they have an ectopic pregnancy from an early scan or if symptoms present themselves later on.

Ectopic Pregnancy Treatment

An ectopic pregnancy can be hard to accept, but it’s important to quickly treat it to prevent serious health problems. Since the fertilized egg cannot survive outside the uterus, the pregnancy cannot be saved. Treatment is required to remove the pregnancy before it grows and causes problems for the organs it implanted on.

There are two main options for treatment that your doctor will review with you. Depending on the symptoms you experienced, the size of the fetus, and the level of pregnancy hormone (human chorionic gonadotropin) in your blood, you may be offered one of the following:

Medication

When a fallopian tube hasn’t ruptured, and the pregnancy is not far along, your doctor can inject you with methotrexate–a medication that stops the pregnancy from progressing.

Surgery

In most cases, a laparoscopy (also known as keyhole surgery) is conducted by creating a small incision in the belly to insert a thin, flexible tube (known as a laparoscope) and surgical instruments to remove the fetus. The fallopian tube may be removed if it’s ruptured or infected.

If the fallopian tube ruptures, emergency surgery is needed. The surgeon will create a larger incision (called a laparotomy) to halt the bleeding and, if possible, repair the damaged fallopian tube.

It can be challenging to come to terms with an ectopic pregnancy. But if you are pregnant and experiencing any alarming symptoms, it’s essential to contact your doctor immediately. Your health matters and the ectopic pregnancy needs to be removed to keep you safe. This also helps your chances of having a healthy pregnancy down the line.