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Let’s get straight to it: an ectopic pregnancy can sometimes be detected by ultrasound as early as 5 weeks after conception — but it’s not always clear-cut. If you're cramping, spotting, or just have a gut feeling that something’s not right after that BFP, you’re not being dramatic. Trust your instincts and get checked out.
An ectopic pregnancy is a medical emergency. It’s the leading cause of pregnancy-related death in the first trimester, accounting for 5–10% of all early maternal deaths. So early detection matters. A lot.
Let’s walk through what to watch for, how it’s diagnosed, what treatment might look like, and the emotional fallout (because that deserves space too).
What is an ectopic pregnancy?
In a typical pregnancy, a fertilized egg makes its way down the fallopian tube and implants in the uterus. In an ectopic pregnancy, the egg gets a little lost — and implants somewhere it shouldn't. Usually that’s in the fallopian tube (about 90% of the time for ectopic pregnancies), but it can also happen in the ovary, cervix, abdomen, or even a C-section scar.
No matter where it implants, an ectopic pregnancy is not viable. There’s no way to move it, and it can’t grow into a healthy baby. If left untreated, it can rupture and cause life-threatening internal bleeding.
How common are ectopic pregnancies?
Roughly 1 in every 50 pregnancies is ectopic. But if you’ve had pelvic inflammatory disease (PID), endometriosis, a previous ectopic, fertility treatments, or abdominal surgery (including C-sections), your risk is higher.
C-section scar ectopic pregnancy
This is rare but serious. Sometimes, the embryo implants in the scar tissue from a previous Cesarean. It’s hard to diagnose and comes with a high risk of uterine rupture. Early scans and specialist care are essential.
Do ectopic pregnancies test positive?
Yes — an ectopic pregnancy will usually show up on a home pregnancy test because your body still produces hCG — the hormone that turns the test positive. But here’s the catch: hCG levels often rise more slowly in ectopic pregnancies.
So, if your lines are staying faint, or your symptoms feel off, that’s worth a call to your doctor. You’re not overthinking it.
Ectopic pregnancy hCG levels
In a healthy pregnancy, hCG levels double roughly every 48–72 hours. In an ectopic pregnancy, hCG may rise much more slowly, plateau, or even drop.
Doctors often use serial hCG testing to track whether your pregnancy is developing normally. Combined with ultrasound, it helps pinpoint what's going on.
Recent research is exploring even more precise markers — like activin-AB and PAPP-A — that might help catch ectopic pregnancies earlier, but they’re not standard practice yet. Some clinics are also using endometrial sampling with manual vacuum aspiration to help confirm location without waiting weeks for clarity.
How early can ectopic pregnancy be detected by ultrasound?
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If your doctor suspects an ectopic pregnancy, they’ll likely book you for a transvaginal ultrasound between 5–6 weeks after conception (that’s about 7 weeks pregnant, going by your last period). Sometimes it can be seen earlier — but not always.
If it’s too early to spot anything definitive on ultrasound, your provider may monitor your hCG levels and repeat the scan every few days until they get a clearer picture.
Info your doctor might ask for:
- First day of your last period
- Any fertility treatments (like IUI or IVF)
- Symptoms you’re having and when they started
- Past surgeries, ectopic history, or conditions like endometriosis or PID
Your doctor may also perform a pelvic exam and run tests. During a pelvic exam, your doctor palpates internal organs to try to locate the ectopic mass. This helps confirm the location of the pregnancy and determine the next steps. However, it’s estimated that over half of the time, OB/GYNs are unable to feel an ectopic mass during a pelvic exam.
What does ectopic pregnancy feel like?
Early on, it might feel like a normal pregnancy — sore breasts, nausea, fatigue. But there are a few red flags to watch out for:
- Sharp or stabbing pain (especially on one side)
- Low back pain
- Abnormal vaginal bleeding (not your typical spotting)
- Dizziness or fainting
- Pain that comes and goes — or gets worse over time
It’s also estimated that over half of the time, OB/GYNs are unable to feel an ectopic mass during a pelvic exam.
Does ectopic pregnancy pain come and go?
Yes, and that can be confusing. Pain may start off mild or sporadic before becoming more severe or constant. If you're feeling a weird, gnawing ache that doesn’t feel like your usual cramps — trust that intuition.
Ectopic pregnancy shoulder pain
It’s weird but real. When internal bleeding irritates the phrenic nerve, it causes referred pain in the shoulder tip. It’s a key sign that something serious is going on — don’t ignore it.
Does your belly grow with an ectopic pregnancy?
No — since the pregnancy isn’t growing in the uterus, you won’t get a visible bump. Some people notice bloating or swelling if there’s internal bleeding, but since it’s not got enough space to grow, it’s not technically a bump.
Ectopic pregnancy bowel symptoms
Gas, bloating, constipation, and rectal pressure can all be symptoms — especially if the ectopic pregnancy is pressing on nearby organs. These are easy to brush off as regular digestive issues, but if something feels “off” alongside bleeding or pelvic pain, get it checked.
Signs of ruptured ectopic pregnancy
If the fallopian tube bursts (aka ruptures), it’s a life-threatening emergency. Call 911 or get to the ER immediately if you have:
- Sudden, severe abdominal pain
- Shoulder pain (yes, shoulder pain — this can be a sign of internal bleeding irritating your diaphragm)
- Feeling faint or actually fainting
- Racing heartbeat or low blood pressure
Can an ectopic pregnancy be saved?
Unfortunately, no, there’s currently no way to safely move the pregnancy into the uterus. If the pregnancy continues to grow in the wrong spot, it can cause serious complications or death. The safest option is to treat it early.
How to terminate an ectopic pregnancy early
It depends on how early the ectopic pregnancy has been caught as to which treatment is recommended, but there are typically two ways to treat an ectopic pregnancy:
- Methotrexate for ectopic pregnancy: This medication stops the pregnancy cells from growing, and your body gradually reabsorbs the tissue over a few weeks. You’ll need regular hCG monitoring to make sure levels drop to zero.
- Surgery for ectopic pregnancy: If methotrexate isn’t an option — or if the pregnancy has ruptured — you’ll likely need laparoscopic surgery. Depending on the damage, your doctor may remove the ectopic pregnancy but leave the tube (salpingostomy) or remove the entire tube (salpingectomy)
How does an ectopic pregnancy resolve itself?
In rare cases, the body resolves an ectopic pregnancy without intervention — but this is risky, unpredictable, and not considered safe medical management. If you're diagnosed, active monitoring and treatment are always recommended.
How to prevent ectopic pregnancy
There’s no surefire way to prevent an ectopic pregnancy, but there are some things that might help lower your risk. Staying on top of your sexual health — like treating any STIs quickly — can protect your reproductive system from inflammation or damage. If you have endometriosis, working with a doctor to manage it can also make a difference. Avoiding smoking is another helpful step, and if you’ve had pelvic surgeries or a history of pelvic inflammatory disease (PID), regular check-ins with your OB-GYN are a good idea.
But here’s the thing: even if you do everything “right,” an ectopic pregnancy can still happen. It doesn’t mean you did anything wrong. It’s not your fault.
Taking care of yourself after an ectopic pregnancy
Let’s be honest: the physical side is only half the story. The emotional aftermath of an ectopic pregnancy can hit just as hard — especially if it’s traumatic or life-threatening.
You might feel grief, anger, fear about future pregnancies, or just totally numb. There’s no “right” way to process it. Find support that works for you — whether that’s therapy, peer groups, journaling, or simply talking it out with someone who gets it.
Getting an ectopic pregnancy ultrasound is an important step in getting the correct diagnosis and treatment. Everyone’s path to recovery after an ectopic pregnancy is different — and it’s important to heal in a way that works for you.
Physical recovery can take time as your body returns to its pre-pregnancy state. As hormones fluctuate, it can also take a few cycles for your menstrual cycle to get back to normal. For many women, the emotional recovery is significant. You may experience a whirlwind of emotions, from sadness to anger, and even confusion. Allow yourself to grieve and elicit the support of family, friends, and professional help as you navigate pregnancy loss.
Medical Disclaimer: The content in this article is provided for informational purposes only. It is not intended to prevent, diagnose, treat, or cure any health conditions. It’s not a substitute for professional medical advice or consultation. Talk to your doctor before making changes to your healthcare regimen.
Tassia O'Callaghan is an experienced content writer and strategist, having written about a vast range of topics from chemical regulations to parenting, for brands like Peanut App Ltd, Scary Mommy, Tally Workspace, and Fertility Mapper. She's an advocate for realistic sustainable living, supporting small businesses (author of A-Z of Marketing for Small Businesses), and equity across all walks of life. Follow her on LinkedIn or TikTok, or see more of her work on Authory or her website.