Early Pregnancy · Urgent Condition

Ectopic Pregnancy and Ultrasound

The symptoms that need immediate care, how ultrasound and blood tests find an ectopic pregnancy, what treatment involves — and what it means for pregnancies afterwards.

If you have these symptoms, go to A&E or call 999 now

Severe or one-sided tummy pain · pain at the tip of your shoulder · heavy vaginal bleeding · feeling faint, dizzy or collapsing · pain when opening your bowels or passing urine alongside bleeding. Do not book a scan and wait. If you suspect an ectopic pregnancy, an Early Pregnancy Assessment Unit or A&E is where you need to be — they can scan, take blood tests and treat, which a private imaging clinic cannot. If symptoms are milder but present, contact your GP, midwife or NHS 111 today rather than waiting.

An ectopic pregnancy is one that implants outside the cavity of the uterus — most often in a fallopian tube, occasionally in the cervix, an ovary, a caesarean scar or the abdomen. The NHS puts the frequency at around 1 in every 90 pregnancies. Such a pregnancy cannot develop safely and cannot be moved to the uterus, and because a growing pregnancy can damage the structure holding it, it needs prompt assessment and treatment. Diagnosed early, it is managed safely and routinely; the danger comes from delay, which is the entire reason this page leads with symptoms rather than explanation.

Recognising It

Symptoms, and why some are easy to miss

Ectopic pregnancy typically declares itself between about 4 and 12 weeks, often before a first scan would be due. The difficulty is that early symptoms overlap with ordinary early pregnancy and with miscarriage:

  • One-sided tummy pain — often persistent, and the most characteristic symptom
  • Vaginal bleeding or brown watery discharge — frequently different from a normal period
  • Shoulder-tip pain — pain right at the point of the shoulder, caused by internal bleeding irritating the diaphragm. Unusual, and an urgent sign
  • Discomfort opening your bowels or passing urine
  • Feeling faint, dizzy or unwell — a sign of possible internal bleeding, needing emergency care

Some ectopic pregnancies cause no symptoms at all and are found on a scan arranged for another reason. And a positive pregnancy test with an empty uterus on scan — a pregnancy of unknown location — is precisely the situation in which ectopic has to be excluded, even when you feel completely well.

Diagnosis

How ultrasound finds an ectopic pregnancy — and its limits

Transvaginal ultrasound is the first-line test, and it works in two ways. Directly, it may show the pregnancy itself outside the uterus — a mass beside the ovary, sometimes with a visible sac, sometimes with free fluid in the pelvis suggesting bleeding. Indirectly and more commonly early on, it shows an empty uterus in someone with a positive pregnancy test, which raises the question rather than answering it.

That distinction matters, because a scan alone frequently cannot exclude an ectopic pregnancy. Very early, there may be nothing large enough to see anywhere. This is why assessment pairs the scan with serial hCG blood tests 48 hours apart: an intrauterine pregnancy typically shows a substantial rise, a resolving miscarriage shows a fall, while levels that rise sluggishly, plateau or behave erratically point towards an ectopic and prompt closer monitoring. Diagnosis usually emerges from the pattern across scan and bloods rather than from one image.

It is also why this is EPAU work rather than private-scan work. The blood tests, the repeat scanning at the right interval, and the ability to treat if the answer is ectopic all sit within the same NHS service. We say this plainly because sending someone away reassured by a single scan would be the dangerous thing to do.

Risk Factors

Who it happens to

Several things raise the chance — previous ectopic pregnancy, previous pelvic infection or pelvic inflammatory disease, endometriosis, previous tubal surgery or sterilisation, conception with an intrauterine device in place, conception through fertility treatment, and smoking. Increasing age is also associated with a modest rise.

The important caveat: many women who have an ectopic pregnancy have none of these risk factors. Their absence is not reassurance and should never delay assessment of symptoms. Equally, having a risk factor does not mean it will happen — it simply means a scan to confirm the pregnancy’s location has more value for you, and is worth mentioning to your GP or midwife early.

Treatment

What happens once it is diagnosed

There are three approaches, and which is appropriate depends on how far along the pregnancy is, your hCG level, whether there is bleeding, and how you are clinically. All are NHS hospital care.

  1. 1
    Expectant managementWhere the pregnancy is very early, hCG is low and falling, and you have no concerning symptoms, it may be monitored with repeat blood tests while it resolves on its own. No medication or surgery, but close follow-up.
  2. 2
    Medical treatment (methotrexate)A medicine given by injection that stops the pregnancy developing, allowing the body to reabsorb it. Suitable in selected cases, and followed by blood tests until hCG returns to zero. You are advised to avoid conceiving for a period afterwards — your team will tell you how long.
  3. 3
    SurgeryUsually keyhole surgery, either removing the affected fallopian tube or, sometimes, removing the pregnancy while preserving the tube. Emergency surgery is needed where there is significant internal bleeding.

One thing worth saying directly: none of these options is a choice about whether to continue the pregnancy. An ectopic pregnancy cannot survive and cannot be relocated to the uterus. That is a genuine loss, and it deserves to be recognised as one rather than treated as a purely surgical matter.

Afterwards

Future pregnancies, and support

The question most people ask next is whether they can conceive again, and the answer is generally reassuring: most women who have had an ectopic pregnancy go on to have a healthy pregnancy afterwards, including many who have had a fallopian tube removed — the remaining tube commonly compensates. The chance of a further ectopic is raised compared with someone who has never had one, which is why an early scan to confirm location is routinely offered in a subsequent pregnancy. Tell your GP or midwife about your history as soon as you have a positive test, so that scan can be arranged.

Support matters here too. An ectopic pregnancy combines bereavement with a medical emergency, often followed by surgery, and people frequently under-rate the impact because everything happened quickly. Our baby loss helplines page lists organisations offering counselling and peer support, and Tommy’s runs a support line staffed by midwives.

FAQs

Your questions answered

Can an ultrasound detect an ectopic pregnancy?
Often yes — transvaginal ultrasound may show the pregnancy outside the uterus, or free fluid suggesting bleeding. But very early it may show only an empty uterus with a positive test, which raises the question rather than answering it. Diagnosis usually needs the scan combined with hCG blood tests 48 hours apart.
What are the first signs of an ectopic pregnancy?
Most commonly one-sided tummy pain, unusual vaginal bleeding or brown watery discharge, and sometimes shoulder-tip pain. Symptoms typically appear between about 4 and 12 weeks. Feeling faint or dizzy suggests internal bleeding and needs emergency care.
Why does shoulder pain happen with an ectopic pregnancy?
Blood leaking into the abdomen irritates the diaphragm, and that irritation is felt as pain at the tip of the shoulder. It is an unusual symptom and an urgent one — treat it as a reason to go to A&E.
Can an ectopic pregnancy be moved to the uterus?
No. There is no procedure that relocates an ectopic pregnancy, and it cannot develop safely where it is. Treatment aims to end it before it causes damage or bleeding — which is why prompt diagnosis matters so much.
Should I book a private scan if I think I have an ectopic pregnancy?
No — go to an Early Pregnancy Assessment Unit or A&E. They can scan, take blood tests, monitor and treat, all in one service. A private imaging clinic can scan but cannot do the rest, and a single scan often cannot exclude an ectopic. If you have severe pain, heavy bleeding, shoulder-tip pain or feel faint, call 999.
Can you have a normal pregnancy after an ectopic?
Most women do, including many who have had a fallopian tube removed. The chance of another ectopic is higher than average, so an early scan confirming the pregnancy’s location is usually offered next time — tell your GP or midwife your history as soon as you have a positive test.
Can an ectopic pregnancy resolve on its own?
Sometimes, and expectant management with close monitoring is a recognised option where the pregnancy is very early, hCG is low and falling, and there are no worrying symptoms. That decision belongs with the hospital team monitoring you, never with waiting at home to see.
Related

Where to go from here

Empty ScanPositive Test, Nothing on Scan

Pregnancy of unknown location — the situation where ectopic is excluded.

Read the guide →SymptomSpotting in Pregnancy

The causes of early bleeding, and which ones need urgent review.

Read the guide →MiscarriageMiscarriage and Ultrasound

What a scan can and cannot detect, and how loss is confirmed.

Read the guide →

Symptoms, frequency and treatment options follow NHS guidance on ectopic pregnancy; assessment pathways follow NICE guideline NG126. Support after pregnancy loss is available from Tommy’s and the organisations on our baby loss helplines page. This article is general information, not individual medical advice. Suspected ectopic pregnancy is a medical emergency — contact NHS 111, an Early Pregnancy Assessment Unit, or attend A&E; call 999 for severe pain, heavy bleeding or feeling faint.

Written and clinically reviewed by the HCPC-registered sonographers who perform this scan at IUS London — a CQC-registered diagnostic ultrasound clinic (Provider ID 1-2775844974). Your own findings are explained to you at the scan and set out in your report.

Author: Yianni Kiromitis, Senior Sonographer, HCPC RA38415
Medically reviewed: 1 August 2026