Ectopic Pregnancy Pain: How to Recognize the Signs

Could abdominal pain in the first trimester signal an ectopic pregnancy? Here's how to spot the rare pregnancy complication.

Doctors may be able to do a blood test to predict miscarriage risk in the future.
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Abdominal pain can raise red flags throughout all stages of pregnancy. But when this symptom occurs early in the first trimester, it could signal an ectopic pregnancy. "An ectopic pregnancy is a pregnancy that occurs anywhere that's not inside the uterus. The most common place is the fallopian tube, but it can rarely be in other places like an ovary or cervix," says Tracy Anderson, M.D., a Kaiser Permanente OB-GYN based in Lakewood, Colorado.

Ectopic pregnancies can't be carried to term. If left untreated, they can result in fallopian tube rupture, internal bleeding, and possible maternal death. That's why it's vital to recognize the signs and symptoms of ectopic pregnancy pain.

When Does Ectopic Pregnancy Pain Start?

Initially, ectopic pregnancies cause normal pregnancy symptoms like breast tenderness, nausea, and a missed menstrual period. But after a few weeks, many people with ectopic pregnancies will develop vaginal bleeding and abdominal pain—although half of ectopic pregnancies come with no unusual symptoms, says Dr. Anderson.

Ectopic pregnancies are typically diagnosed after 6 to 8 weeks of pregnancy, according to Dr. Mark D. Levie, professor of OB-GYN and women's health at the Albert Einstein College of Medicine. But he notes there are exceptions to the rule. For example. if the ectopic pregnancy happens somewhere outside the fallopian tubes (such as in a C-section scar), symptoms may appear later.

Types of Ectopic Pregnancy Pain

Abdominal Pain

The most common symptoms of ectopic pregnancy are bleeding or spotting during the first trimester and abdominal pain, says Dr. Levie. The pain usually appears in the lower abdomen or pelvic region—often localized on one side of the body. It can feel dull or crampy, be continual or scattered, and possibly worsen with movement. As the ectopic pregnancy progresses, abdominal pain may become severe and sharp. You might also have nausea, diarrhea, and bowel pain.

Shoulder Pain

In the later stages of ectopic pregnancies, the fallopian tube can rupture. Internal blood can collect under the diaphragm, leading to nerve irritation. This often causes pain in the shoulder and neck. If you suspect this is happening, seek medical care immediately.

Other Types of Ectopic Pregnancy Pain

Progressed ectopic pregnancies have also been associated with lightheadedness, weakness, and fainting. Again, seek medical attention immediately if you notice these symptoms.

What To Do If You Suspect Ectopic Pregnancy

Ectopic pregnancy pain can vary for everyone, which is why it's vital to see a doctor if you experience any abdominal discomfort or bleeding during the first trimester. Note that light spotting and cramping can also signal a healthy early pregnancy, so these symptoms don't automatically mean your fetus is developing outside the uterus. Still, it's better to be safe than sorry.

Your doctor will rely on a variety of methods, including ultrasound and quantitative hCG blood tests, to make sure the fetus is normal, says Dr. Levie. If they spot an ectopic pregnancy, doctors usually rely on a medication called methotrexate to treat it, thus ending the pregnancy. Laparoscopic surgery may be used for large, advanced, or ruptured ectopic pregnancies, says Dr. Levie. With proper treatment, a person should fully recover, and they're likely to have healthy pregnancies in the future.

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