Ectopic pregnancy care (Ectopic pregnancy management)
How a pregnancy growing in the wrong place (most often a fallopian tube) is diagnosed and treated, by watching and waiting, an injection, or keyhole surgery.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- An ectopic pregnancy grows outside the womb (usually in a fallopian tube) and cannot continue safely — it needs urgent assessment, not a routine booking.
- Sudden severe one-sided tummy pain, shoulder-tip pain, faintness, collapse or heavy bleeding when you could be pregnant is a 999/A&E emergency.
- Treatment can be watchful monitoring, a methotrexate injection, or keyhole surgery; your hormone level and how well you are guide the safest choice.
- Most people go on to have a healthy pregnancy afterwards, though the chance of another ectopic is slightly higher, so early scans in future pregnancies matter.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Removes or resolves a pregnancy that cannot grow safely and could otherwise be life-threatening
Watch-and-wait and methotrexate are not safe if you have signs of rupture, severe pain or significant internal bleeding — these need urgent surgery.
After keyhole surgery you may have tummy soreness, shoulder-tip discomfort from the gas used, and tiredness. After methotrexate you may have cramping...
Clear written emergency instructions with a 24-hour phone number.
After keyhole surgery you may have tummy soreness, shoulder-tip discomfort from the gas used, and tiredness. After...
Many people feel physically much better within a week or two after keyhole surgery. Light bleeding can continue...
Whichever treatment you had, you will have blood tests until your pregnancy hormone is undetectable. With...
Emotional recovery often takes longer than physical recovery. Grief, anxiety and worry about future pregnancies...
What is an ectopic pregnancy and how is it treated?
An ectopic pregnancy is when a fertilised egg starts to grow somewhere other than the lining of the womb — most often in a fallopian tube. A pregnancy cannot grow safely in these places, and as it grows it can damage or split open (rupture) the tube. This can cause dangerous internal bleeding.
This is why an ectopic pregnancy is treated as an emergency, not a routine appointment. Severe one-sided tummy pain, pain at the tip of your shoulder, feeling faint or collapsing, or heavy bleeding when you could be pregnant means you should call 999 or go to A&E straight away.
When it is caught early, an ectopic pregnancy can sometimes be watched carefully (if your hormone levels are low and falling), treated with an injection of a medicine called methotrexate, or removed with keyhole surgery. Which option is safest depends on your symptoms, your pregnancy hormone level, the scan findings and your own wishes.
Nothing you did caused this, and an ectopic pregnancy can happen to anyone. It is a loss of a pregnancy as well as a medical emergency, and the emotional impact deserves the same care as the physical treatment.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Comparing the main treatment options
| Option | Who it may suit | Key trade-off |
|---|---|---|
| Watch and wait | Few symptoms, low and falling hormone level | Needs repeat blood tests; may still need treatment later |
| Methotrexate injection | Well, no rupture, lower hormone level | Avoid pregnancy for a few months after; some need a second dose or surgery |
| Keyhole surgery (tube removed) | Healthy other tube, or unwell/ruptured | Loses one tube, but lowest risk of another ectopic |
| Keyhole surgery (tube kept) | Other tube already damaged | Higher chance of another ectopic; may need more treatment |
This is a general guide only. Your team will recommend the safest option for your situation, and emergencies are always treated surgically and without delay.
Preparing for your treatment
- If you are being monitored or having methotrexate, you will be told exactly when to return for blood tests and when to seek urgent help — keep these instructions to hand.
- If you have methotrexate, you must avoid alcohol, certain painkillers (such as ibuprofen) and folic acid supplements as advised, and use reliable contraception for the time your team recommends (often around three months) because the medicine can harm a future pregnancy.
- For surgery, you will usually be asked not to eat or drink for a set time beforehand, as it is done under general anaesthetic.
- Tell the team about all your medicines, allergies and any bleeding disorders.
- Arrange a lift home and someone to stay with you for the first day or two after surgery or an injection.
- If your blood group is rhesus (RhD) negative, ask your team whether you need an anti-D injection — the guidance for England changed in June 2026 and now depends on how many weeks pregnant you are (see the FAQ below).
- Bring a list of your questions — this is a stressful time, and it is easy to forget things.
What happens
Diagnosis usually involves a urine or blood pregnancy test, an internal (transvaginal) ultrasound scan, and one or more blood tests to measure your pregnancy hormone (hCG). Sometimes the pregnancy cannot be seen at first and you are asked to return for repeat tests over a few days — this is called a 'pregnancy of unknown location' and is followed carefully.
If watch-and-wait is chosen, you have regular blood tests to check the hormone level is falling, and you are given clear instructions to seek urgent help if symptoms develop.
Methotrexate is given as an injection, usually into a muscle. You then have blood tests on set days to check it is working. You may feel some tummy cramping in the first week.
Surgery is done by keyhole (laparoscopy) where possible: small cuts in your tummy, a camera and instruments, usually under general anaesthetic. The affected tube is either removed or, less often, the pregnancy is removed and the tube kept. Most people go home the same day or the next day.
If your blood group is rhesus (RhD) negative, your team will check whether you need an anti-D injection — a medicine, made from donated blood plasma, that can help protect a future pregnancy. Under the current guidance for England (updated June 2026), this is not routinely given for an ectopic pregnancy treated at or before 11 weeks and 6 days, including keyhole surgery, but it is offered if you are between 12 weeks and 12 weeks 6 days pregnant. Elsewhere in the UK your hospital follows its own local protocol, so ask what applies to you.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Watch-and-wait and methotrexate are not safe if you have signs of rupture, severe pain or significant internal bleeding — these need urgent surgery.
- Methotrexate is not suitable if your pregnancy hormone is high, if a heartbeat is seen in the ectopic, or if you cannot attend reliable follow-up.
- Methotrexate is avoided in certain blood, liver or kidney conditions, and while breastfeeding.
- Keeping the tube (salpingotomy) may be unwise if the other tube is healthy, as removing the affected tube lowers the risk of another ectopic.
Delay or rearrange if…
- You have any emergency warning signs — do not delay; this needs immediate care, not a wait.
- You cannot get to hospital quickly or cannot attend follow-up blood tests, which makes non-surgical treatment unsafe.
- Key results (such as hormone levels or scan findings) are not yet available to guide the safest choice.
- You feel rushed into a decision in a non-emergency situation and want time to understand your options.
Alternatives to discuss
- Choosing surgery rather than methotrexate (or the reverse) where both are reasonable for you.
- Watchful monitoring instead of active treatment when the hormone level is low and falling.
- Removing the tube versus keeping it, weighed against future fertility.
- Time and support to make a decision when there is no immediate danger.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Removes or resolves a pregnancy that cannot grow safely and could otherwise be life-threatening
- Reduces the risk of the fallopian tube splitting open and causing serious internal bleeding
- Several options mean treatment can often be tailored to how well you are and your wishes
- Most people remain able to conceive afterwards, even with one fallopian tube
- Follow-up blood tests confirm the pregnancy hormone has fully cleared
Risks & complications
- Tummy cramping and some vaginal bleeding for a while after treatment
- Tiredness and feeling emotionally low — this is a pregnancy loss as well as an emergency
- Side effects from methotrexate such as nausea, mouth ulcers or feeling washed out
- Needing repeated blood tests and clinic visits until your hormone level reaches zero
- Methotrexate not fully working, so a second injection or surgery is needed
- Wound infection or bruising after keyhole surgery
- A reaction to the general anaesthetic
- Needing to convert from keyhole to open surgery
- Heavy internal bleeding if the tube ruptures, needing emergency surgery and sometimes a blood transfusion
- Damage to nearby organs during surgery
- Blood clots in the legs or lungs after an operation
- Very rarely, an ectopic pregnancy can be life-threatening, which is why urgent care matters
The most important risk is delay. If you are being managed with watch-and-wait or methotrexate, you must know the emergency warning signs and be able to get to hospital quickly. Ask your team exactly what to look out for, who to call day or night, and how soon you will be reviewed. If you ever feel faint, collapse, or have severe one-sided pain or shoulder-tip pain, call 999.
Published figures to discuss
Outcomes vary a great deal with how early the ectopic is found, your pregnancy hormone level and your symptoms. The figures below come from UK sources (RCOG and NICE) and are guides, not promises; your own team will explain what they mean for you.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Chance a pregnancy is ectopic | Around 1 in 90 pregnancies (just over 1%) in the UK | Higher if you have had a previous ectopic, tubal damage, IVF, or conceived with a coil or progestogen-only pill in place. | NHS — Ectopic pregnancynhs.ukPublished figure |
| Needing a second methotrexate injection | Around 15 in 100 (15%) | Follow-up blood tests show whether the first injection has worked. | NHS — Ectopic pregnancynhs.ukPublished figure |
| Needing surgery despite methotrexate | Around 7 in 100 (7%) | Surgery is done if methotrexate does not work or symptoms worsen. | NHS — Ectopic pregnancynhs.ukPublished figure |
| Another ectopic in a future pregnancy | Around 7–10 in 100 (7–10%) | Higher than average, so an early scan is recommended next time. Most future pregnancies are still in the womb. | NHS — Ectopic pregnancynhs.ukPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery has two parts: the physical recovery from the treatment, and the emotional recovery from losing a pregnancy in a frightening way. Both are real and both deserve support.
- Some tummy cramping and vaginal bleeding or spotting for a week or two
- Tiredness, and feeling more emotional than usual
- Shoulder-tip ache after keyhole surgery (from the gas), which settles
- Waiting weeks for the pregnancy hormone to fall to zero with non-surgical treatment
- Mixed feelings — relief, sadness and anxiety can all come at once
Aftercare
- Attend every follow-up blood test until you are told your hormone level has reached zero — this confirms treatment has worked.
- If you had methotrexate, avoid alcohol, ibuprofen-type painkillers and folic acid as advised, and protect your skin from strong sun.
- Use reliable contraception for as long as your team recommends after methotrexate before trying again.
- Take it easy after surgery; build activity back gradually and avoid heavy lifting at first.
- Look out for the emergency warning signs and keep your urgent-contact number to hand.
- Ask about counselling or support — for you and your partner — and about what happens in a future pregnancy.
- See your GP if low mood, anxiety or grief is not easing; help is available.
- Written emergency instructions and a 24-hour contact number
- Dates of your follow-up blood tests noted
- Simple pain relief at home (avoid ibuprofen after methotrexate)
- Someone to stay with you for the first day or two
- A plan for contraception and when it is safe to try again
- Details of support and counselling services
- Time off work arranged
Scars and how they heal
If you have keyhole surgery, you will have a few small cuts (usually one near your tummy button and one or two lower down). These are small and usually fade to faint marks over months. If open surgery is needed in an emergency, the scar is larger. Watch-and-wait and methotrexate treatment leave no scars.
⚠ Get urgent help if…
- Sudden, severe or one-sided tummy pain — call 999 or go to A&E
- Pain at the tip of your shoulder — this can be a sign of internal bleeding; seek emergency help
- Feeling faint, dizzy, very pale, or collapsing — call 999
- Heavy vaginal bleeding, or passing large clots
- A fast heartbeat, breathlessness or feeling something is very wrong
- Fever, severe tummy pain or a smelly discharge after surgery (possible infection)
- After methotrexate: severe tummy pain that does not settle, or breathing problems — seek urgent help
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome means the ectopic pregnancy has been treated and your pregnancy hormone (hCG) has fallen to zero, with no lasting harm to you. Your team confirms this with blood tests rather than a single appointment.
Treatment cannot bring back the pregnancy, and it is right to allow time to grieve. It also cannot promise that a future pregnancy will not be ectopic — but most people who have had one ectopic pregnancy go on to have a healthy pregnancy.
Once your hormone level reaches zero, the ectopic pregnancy is resolved and does not come back. However, having had one ectopic pregnancy increases the chance of another in future, so an early scan (around 6–7 weeks) is usually recommended next time to check the pregnancy is in the right place.
Related tests, treatments or support
Care for an ectopic pregnancy often sits alongside an early pregnancy assessment, blood-group testing (and an anti-D injection if you are rhesus negative and it is needed for the stage of your pregnancy), and emotional support or counselling. If you have had recurrent early pregnancy problems, your team may suggest further investigations.
Follow-up & long-term care
Follow-up is built around blood tests that track your pregnancy hormone until it is undetectable. You should also be offered a chance to talk through what happened and ask questions, and advice on trying again and on early scans in a future pregnancy. Report any return of pain or bleeding straight away.
- Attend all hormone (hCG) blood tests until the level reaches zero.
- Wait the recommended time after methotrexate before trying to conceive again.
- Arrange an early scan in any future pregnancy to confirm it is in the womb.
- Seek support if grief or anxiety persists.
Repeat, follow-on and what comes next
- Some people who start with methotrexate or monitoring still need surgery later if things do not settle.
- A second methotrexate injection is needed in a minority of cases.
- If a tube is kept (salpingotomy), occasionally pregnancy tissue remains and more treatment is needed.
- Future pregnancies are watched more closely because of the higher chance of another ectopic.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear written emergency instructions with a 24-hour phone number.
- Blood-test follow-up continued until the pregnancy hormone reaches zero.
- A chance to talk through what happened, plus access to counselling for you and your partner.
- Advice on contraception, when to try again, and an early scan in any future pregnancy.
- A named route back into care if pain or bleeding returns.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether emergency care is needed — emergencies are managed by the NHS, not arranged privately
- The type of treatment (monitoring, methotrexate injection, or keyhole surgery)
- Whether you are seeing a private gynaecologist for follow-up or future-pregnancy advice
- Number of follow-up blood tests and scans until the hormone level clears
- Counselling or emotional support services
- Any further fertility investigations if recurrent early pregnancy problems are a concern
- That emergency care is provided by the NHS and not something to delay for a private booking
- What any private follow-up consultation includes (review, scan, blood tests)
- Whether follow-up blood tests until the hormone clears are included
- Whether counselling or support is offered
- What happens, and who to contact, if symptoms return
- Costs of any future-pregnancy early scan or fertility assessment
On the NHS? Ectopic pregnancy is a medical emergency managed by the NHS through early pregnancy units and A&E; it is not a routine private booking, although you may see a private gynaecologist for follow-up advice afterwards.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being offered methotrexate or watch-and-wait without clear, written emergency instructions and a 24-hour contact.
- Not being told that methotrexate means avoiding pregnancy, alcohol and certain painkillers for a set time.
- Not understanding the difference between removing the tube and keeping it, and how each affects future fertility.
- Treating the situation as purely a medical problem without acknowledging it is also a pregnancy loss.
- Not being told about anti-D if you are rhesus negative.
Marketing red flags
- Any private service suggesting an ectopic pregnancy can wait for a routine appointment — it cannot.
- Claims that one treatment is always best, regardless of your hormone level and symptoms.
- Reassurance that future fertility is 'guaranteed' — it is usually good, but not guaranteed.
- Downplaying the emotional impact, or not offering support.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Based on my hormone level and scan, which treatment is safest for me and why?
- If I am being monitored or having methotrexate, exactly what symptoms mean I should call 999?
- Who do I contact day or night, and how quickly will I be seen?
- Will you remove my tube or try to keep it, and how does that affect future pregnancies?
- If I am rhesus negative, do I need an anti-D injection at this stage of my pregnancy?
- When is it safe to try for another pregnancy, and will I get an early scan?
- What emotional support and counselling can you offer me and my partner?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is an ectopic pregnancy an emergency?
Was this my fault?
Will I still be able to have a baby?
Why might I need my fallopian tube removed?
How does the methotrexate injection work?
Is this treated on the NHS?
Do I need an anti-D injection if I'm rhesus negative?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Ectopic pregnancy NHS — Ectopic pregnancy: symptoms RCOG — Ectopic pregnancy (patient information) NICE NG126 — Ectopic pregnancy and miscarriage: information for the public The Ectopic Pregnancy Trust — signs and symptoms The Ectopic Pregnancy Trust — medical management with methotrexate NICE NG126 — anti-D immunoglobulin prophylaxis
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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