Symptoms of an Ectopic Pregnancy

A missed or late period

If you have missed one or more periods, the most likely reason is that you have become pregnant, and it is progressing as it should. However, if you experience typical pregnancy symptoms, such as nausea, painful breasts or a swollen abdomen but no bleeding or pain, this does not completely rule out an ectopic pregnancy, although this is rare. A true period should be normal flow and duration for you. A light period may be abnormal bleeding in pregnancy and should be investigated with a pregnancy test.

Vaginal bleeding

Ongoing bleeding that is sometimes red or brown/black and watery (like “prune juice”) should be investigated. The bleeding may be heavier or lighter than usual. Prolonged off/on light and sometimes heavy bleeding are quite often seen in ectopic pregnancy and should always prompt a pregnancy test and if positive should be urgently investigated with an Early Pregnancy Unit (EPU) referral.

When seeking medical attention, you will be asked for your last menstrual period which should be your last episode of a normal flow and duration bleeding. It is important that abnormal bleeding does not get confused with a normal period as healthcare professionals may think you are much less pregnant than you are.

Pregnancy test

Pregnancy test kits that are available now are very sensitive. They can be positive before you have missed your period. It is sensible to perform the test in the morning when urine contains the most pregnancy hormone (Human Chorionic Gonadotropin or hCG). Very rarely a pregnancy test can give a falsely negative result. This is usually because the hormone level is low. If you do a pregnancy test and are surprised by a negative result, repeat the test perhaps with a different pregnancy test kit. If it is still negative and you still think you are pregnant, your doctor can do a blood test to measure the hCG (pregnancy hormone) levels accurately.

If you are in pain and/or bleeding and your home pregnancy test is negative, but you think it should be positive, ensure you are seen by a doctor urgently by attending your local Accident & Emergency department or by contacting your specialist Early Pregnancy Unit.

The blood test that doctors would perform is for hCG which is a hormone produced in pregnancy. HCG is commonly detected in urine by using a urinary pregnancy test, which can show as positive or negative. Blood tests can identify the exact hCG level in the blood. Your GP can do this test, but it will take a few days to get the result, while the hospital and EPU will have the result in a few hours. This is why, if you have symptoms and a surprisingly negative urine pregnancy test, it is better to be seen at the hospital.

Abdominal pain

During pregnancy, it is not uncommon to experience a period-like ache in your lower tummy and back. However, the following should be investigated:

• One-sided pain in your tummy which may be persistent (which means it continues) or intermittent (which means it comes and goes). The pain may have begun suddenly or been gradual.
• Discomfort with bloating and a feeling of fullness (not associated with eating) when lying down, particularly if you have already had a child.
• Significant lower abdominal and/or back pain.

Shoulder tip pain

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. 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. The pain may have begun suddenly.

Shoulders cause pain when we are stressed because we hold ourselves more rigidly and muscles in the back and neck go in to spasm or you may have slept in an awkward position – this is most likely not shoulder tip pain related to an ectopic pregnancy.

Shoulder tip pain tends to develop with other symptoms such as feeling unwell, abdominal pain or vaginal bleeding, faintness, abdominal bloating and fullness, or pain when opening your bowels (poo).

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.

Bladder or bowel problems

• Diarrhoea
• Pain when you have your bowels open (go for a poo)
• Pain when you pass water (have a wee)
• Shooting/sharp vaginal pain

Some pain and a change in your normal bladder and bowel pattern are features of a typical pregnancy for some. All the same, if you present at your doctor/GP or Early 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 or slowing pulse rate or falling blood pressure may also be present