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Under normal conditions, for a pregnancy to occur, the fertilized egg must implant into the inner lining of the uterus. However, in the case of an ectopic pregnancy, the fertilized egg does not implant inside the uterus but instead implants outside the uterus — most commonly in the fallopian tubes — and begins to develop there. More than 90% of all ectopic pregnancies occur in the fallopian tubes [1].
This type of abnormal pregnancy can cause life-threatening bleeding and therefore must be terminated. Early diagnosis and prompt treatment are critically important to preserve the future fertility of the mother [2].
What Causes an Ectopic Pregnancy?
Having a previous ectopic pregnancy, tubal pathologies, and assisted reproductive techniques are among the most important risk factors [2]. The main causes include [1, 2]:
- Genetic and congenital abnormalities
- Infections affecting the structure and function of the fallopian tubes
- Damage to the fallopian tubes during previous surgeries
- Hormonal imbalances
- History of ectopic pregnancy
- Pelvic inflammatory disease (PID)
- Endometriosis
- Pregnancy despite tubal ligation
- Smoking
Important note: Approximately half of women who experience an ectopic pregnancy have no identifiable risk factor [1].
What Are the Symptoms of an Ectopic Pregnancy?
The symptoms of an ectopic pregnancy can resemble those of a normal pregnancy. Nausea and breast tenderness are common. These may be accompanied by dizziness and sensitivity to smells. However, distinguishing symptoms include severe pain on one side of the abdomen and vaginal bleeding. If the fallopian tube ruptures, sudden severe pain, shoulder pain, and hemodynamic instability may occur — this is a medical emergency [1].
For more detailed information about ectopic pregnancy, you can visit our page what is ectopic pregnancy and why does it occur?.
How Is an Ectopic Pregnancy Diagnosed?
The current gold standard for diagnosis is the combination of transvaginal ultrasound and serial beta-HCG blood tests [2]. Pregnancy is first confirmed with a beta-HCG test. If ectopic pregnancy is suspected, the test is repeated at specific intervals. Transvaginal ultrasound helps determine the location of the pregnancy. In cases where diagnosis is unclear, laparoscopy may be used as a diagnostic tool [2].
How Is Ectopic Pregnancy Surgery Performed?
Treatment options for ectopic pregnancy include medical (methotrexate), surgical, and expectant management. The choice of treatment depends on the beta-HCG level, the patient’s hemodynamic stability, and the risk of tubal rupture [2].
In hemodynamically stable patients without tubal rupture, methotrexate is the preferred medical treatment. When surgery is required, laparoscopy performed under general anesthesia is the most commonly preferred method according to ACOG guidelines [1]. This procedure is performed by inserting a camera and surgical instruments through small abdominal incisions. Depending on the case, either salpingectomy (removal of the fallopian tube) or salpingostomy (removal of the pregnancy while preserving the tube) is performed.
If laparoscopic surgery is not feasible or poses significant risks — such as in cases of tubal rupture, excessive intra-abdominal bleeding, or poor overall patient condition — open surgery is preferred.
Postoperative Considerations
- Showering should be avoided for the first two days after surgery to reduce infection risk.
- Patients can usually return to normal daily activities within 3–4 days.
- Light spotting may occur due to hormonal changes after surgery.
- It is recommended to avoid sexual activity for about one month until full recovery is achieved.
- Menstruation typically resumes about one month after surgery.
- Pregnancy can usually be attempted approximately 3 months after surgery.