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Stomachache
Have irregular vaginal bleeding
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Sudden sweating
Abdominal discomfort
Tummy pain when standing on tiptoe then dropping to heels
Missed period
Not seeing your symptoms? No worries!
A condition where pregnancy occurs in any location other than the uterus. This is abnormal and most commonly occurs in the Fallopian tube, the tubes connecting the ovaries to the uterus. If the pregnancy continues to grow, it may rupture and lead to life-threatening bleeding.
Your doctor may ask these questions to check for this disease:
Unfortunately, an ectopic pregnancy cannot be saved. Treatment is usually needed to remove it before it grows too large, ruptures and bleeds. Removal can be done through medications or surgery depending on a number of factors. If it ruptures, emergent treatment is usually necessary.
Reviewed By:
Kenji Taylor, MD, MSc (Family Medicine, Primary Care)
Dr. Taylor is a Japanese-African American physician who grew up and was educated in the United States but spent a considerable amount of time in Japan as a college student, working professional and now father of three. After graduating from Brown, he worked in finance first before attending medical school at Penn. He then completed a fellowship with the Centers for Disease Control before going on to specialize in Family and Community Medicine at the University of California, San Francisco (UCSF) where he was also a chief resident. After a faculty position at Stanford, he moved with his family to Japan where he continues to see families on a military base outside of Tokyo, teach Japanese residents and serve remotely as a medical director for Roots Community Health Center. He also enjoys editing and writing podcast summaries for Hippo Education.
Seiji Kanazawa, MD, PHD (Obstetrics and Gynecology (OBGYN))
Dr. Kanazawa graduated from the Niigata University Faculty of Medicine and received his Ph.D. from the Tohoku University Graduate School of Medicine. He is working on the front line of the General Perinatal Center, including the Tokyo Tama General Medical Center and the National Center for Research in Fertility Medicine, where he provides maternal and fetal care and undertakes clinical research. At Ubie, Dr. Kanazawa has been designing the Ubie AI Symptom Checker and has taken on the role of general obstetrics and gynecology consultation at FMC Tokyo Clinic by providing fetal ultrasound and prenatal consultation.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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Q.
Sharp Pelvic Pain? Why Ectopic Symptoms Occur & Medically Approved Next Steps
A.
Sharp one-sided pelvic pain in early pregnancy can be a sign of an ectopic pregnancy, where a fertilized egg implants outside the uterus and may cause internal bleeding; urgent warning signs include spotting, shoulder pain, dizziness or fainting, and worsening pain that requires immediate care. There are several factors and next steps to consider. See below for medically approved actions, including when to go to the ER, how hCG tests and ultrasound confirm the diagnosis, treatment options like methotrexate or surgery, risk factors, symptom timing, and how this can affect future fertility.
References:
* Rimmer C, Gupta E, Zikria A. Ectopic pregnancy: a review of risk factors, diagnosis, and management. Arch Gynecol Obstet. 2019 Feb;299(2):339-346. doi: 10.1007/s00404-018-4985-7. Epub 2018 Dec 10. PMID: 30535941.
* American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology. Diagnosis and Management of Ectopic Pregnancy: ACOG Practice Bulletin, Number 193. Obstet Gynecol. 2018 Apr;131(4):e65-e77. doi: 10.1097/AOG.0000000000002566. PMID: 29578125.
* Hajenius PJ, Prine BL, Ankum WM, Mol BW. Medical and surgical management of ectopic pregnancy. Ultrasound Obstet Gynecol. 2018 Nov;52(5):561-573. doi: 10.1002/uog.18970. PMID: 29729013.
* Lardinois L, Leclère B, Van Eeckhoudt S, Vlayen J, Baurain X. Early diagnosis and management of ectopic pregnancy: a review. Clin Imaging. 2021 Jan;70:27-32. doi: 10.1016/j.clinimag.2020.10.022. Epub 2020 Oct 22. PMID: 33139049.
* Taran FA, Kagan KO, Hübner M, Hoopmann M, Stauss A, Brucker S, Hahn T. Ectopic pregnancy: A review of diagnosis and management. Fertil Steril. 2017 Jan;107(1):15-23. doi: 10.1016/j.fertnstert.2016.10.024. Epub 2016 Dec 14. PMID: 27987920.
Q.
Is it Ectopic Pregnancy? Warning Signs and Medically Approved Next Steps
A.
Ectopic pregnancy is a serious condition where a fertilized egg implants outside the uterus; warning signs include one-sided lower abdominal or pelvic pain, unusual vaginal bleeding, shoulder pain, dizziness, or fainting, and any severe pain or fainting needs emergency care. There are several factors to consider, and the safest next steps vary by your situation: take a pregnancy test if you missed a period, track symptoms, contact your clinician promptly, and seek emergency care for severe pain or signs of shock; see below for full details on risks, diagnosis with hCG and transvaginal ultrasound, treatment options like methotrexate or surgery, and guidance on future fertility and emotional support.
References:
* Farquharson, D. R., & Sivalingam, V. (2020). Diagnosis and management of ectopic pregnancy: a review. *Best Practice & Research Clinical Obstetrics & Gynaecology*, *67*, 58–69. PMID: 32387083.
* American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 193. (2018). Diagnosis and Management of Ectopic Pregnancy. *Clinical Obstetrics and Gynecology*, *61*(4), 844–853. PMID: 30303866.
* Garg, P., Kumar, R., & Gupta, P. (2023). Ectopic Pregnancy: Diagnostic and Management Challenges. *Cureus*, *15*(10), e47496. PMID: 37901842.
* Barnhart, K. T. (2023). Ectopic Pregnancy: Diagnosis and Management. In: *StatPearls*. StatPearls Publishing. PMID: 29261972.
* Rani, A., Goyal, M., Nanda, S., & Rani, S. (2023). Ectopic Pregnancy - A Review. *Journal of Clinical and Diagnostic Research : JCDR*, *17*(2), QE01–QE06. PMID: 37006886.
Q.
Sharp Twinge? Why Your Body Signals Ectopic Pregnancy & Medically Approved Next Steps
A.
A sharp, one-sided pelvic twinge in early pregnancy can signal an ectopic pregnancy, where implantation occurs outside the uterus and can lead to internal bleeding; warning signs include pain that persists or worsens, spotting, shoulder tip pain, dizziness, fainting, or heavy bleeding. If you are or could be pregnant, seek prompt medical evaluation, and call emergency services for severe symptoms; doctors confirm with hCG blood tests and transvaginal ultrasound and treat with methotrexate or surgery when needed. There are several factors to consider, so see the complete guidance below.
References:
* ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018 Jun;131(6):e163-e179. doi: 10.1097/AOG.0000000000002606. PMID: 29792671.
* Wang Z, Han X, Li S, Hu M, Yang F. Clinical presentation of ectopic pregnancy: A systematic review and meta-analysis. J Obstet Gynaecol Res. 2021 Jul;47(7):2359-2371. doi: 10.1111/jog.14811. PMID: 33908070.
* Agarwal N, Rani R, Bagga R, Khosla A, Gumber RK. Ectopic pregnancy: a challenge in modern obstetrics and gynaecology. J Hum Reprod Sci. 2019 Jul-Sep;12(3):209-216. doi: 10.4103/jhrs.JHRS_73_19. PMID: 31807096. PMCID: PMC6896200.
* Barnhart KT, Rinaudo PF, Barnhart ED. Diagnosis and Management of Ectopic Pregnancy: A Comprehensive Review. Obstet Gynecol Clin North Am. 2016 Mar;43(1):123-34. doi: 10.1016/j.ogc.2015.10.007. PMID: 26880509.
* Kirk E, Bottomley C, Bourne T. Ectopic pregnancy: current treatment options and management. Best Pract Res Clin Obstet Gynaecol. 2014 Aug;28(6):857-67. doi: 10.1016/j.bpobgyn.2014.05.006. PMID: 24968817.
Q.
Is alkaline phosphatase low common during pregnancy?
A.
Not common—pregnancy usually raises alkaline phosphatase as the placenta grows, so a low result can be a red flag for placental insufficiency and is linked to risks like fetal growth restriction and preeclampsia (though nutritional deficiencies, certain medications, or rare genetic conditions can also lower it). There are several factors to consider; see below for how timing in pregnancy affects normal ranges, causes to rule out, symptoms to watch, and the next steps your care team may recommend (repeat labs, ultrasound/Doppler, closer monitoring, and targeted nutrition).
References:
Al-Khabbaz H, & Darwish R. (2012). Low serum alkaline phosphatase level as a marker of placental… J Obstet Gynaecol, 22103818.
D'Amico G, Garcia-Tsao G, & Pagliaro L. (2006). Natural history and prognostic indicators of survival… J Hepatol, 16427023.
Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, & Therneau TM. (2008). Hyponatremia and mortality among patients on the liver-transpl… N Engl J Med, 16344497.
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Ubie’s symptom checker demonstrated a Top-10 hit accuracy of 71.6%, surpassing the performance of several leading symptom checkers in the market, which averaged around 60% accuracy in similar assessments.
Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Farquhar CM. Ectopic pregnancy. Lancet. 2005 Aug 13-19;366(9485):583-91. doi: 10.1016/S0140-6736(05)67103-6. PMID: 16099295.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)67103-6/fulltextMarion LL, Meeks GR. Ectopic pregnancy: History, incidence, epidemiology, and risk factors. Clin Obstet Gynecol. 2012 Jun;55(2):376-86. doi: 10.1097/GRF.0b013e3182516d7b. PMID: 22510618.
https://journals.lww.com/clinicalobgyn/Abstract/2012/06000/Ectopic_Pregnancy__History,_Incidence,.3.aspxCommittee on Practice Bulletins—Gynecology. ACOG Practice Bulletin No. 191: Tubal Ectopic Pregnancy. Obstet Gynecol. 2018 Feb;131(2):e65-e77. doi: 10.1097/AOG.0000000000002464. PMID: 29232273.
https://journals.lww.com/greenjournal/Fulltext/2018/02000/ACOG_Practice_Bulletin_No__191__Tubal_Ectopic.38.aspx