Ectopic pregnancy: symptoms and early signs as expert warns of missed diagnoses

Failures to diagnose ectopic pregnancies in women are leading to avoidable deaths and harm, one of the country’s leading experts on maternal health has warned.

Professor Marian Knight from the University of Oxford, who leads a national research programme on maternal deaths, told The Guardian that more action is needed to improve the diagnosis of an ectopic pregnancy - which is a life-threatening condition.

If this was done it would “prevent more women from dying from ectopic pregnancy,” she said, which is currently being caused by the lack of “basic recognition and management of the condition”.

Her warning came as new data obtained by a Freedom Of Information request from the National Reporting and Learning System, a confidential NHS reporting system, revealed that more than 5,000 patient safety incidents in the past five years mentioned “ectopic pregnancy”. Of these cases, 358 lead to “moderate harm”, 48 to “severe harm”, and four resulted in death - two of which occurred in 2022.

Professor Knight said: “We’ve got figures here showing that there are substantial numbers of women suffering severe harm after presenting with ectopic pregnancy and we need to know why that is happening and what can happen to reduce it.

“There must be some top-level messages that we could get out there to make a difference to women. There is no point in data collection without doing something about it.”

Munira Oza, the director of the Ectopic Pregnancy Trust, added: “It is shocking that women are still suffering severe harm and even dying from ectopic pregnancy. Despite good care, women are losing their lives. Deaths and harm due to ectopic pregnancy are avoidable and no woman should lose their life to the condition in this day and age.”

Meanwhile, an NHS spokesperson told The Guardian: “While ectopic pregnancies are rare, clinicians should follow the National Institute for Health and Care Excellence guidelines to recognise the signs, and maternity services across the country should work closely with A&E and primary care teams to share recommendations so that best practice is followed.”

But what is an ectopic pregnancy, and what early signs and symptoms should you look out for? Here’s everything you need to know about the condition.

What is an ectopic pregnancy?

An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes - which connect the ovaries to the womb. If an egg gets stuck in one of these tubes, it will not be able to develop into a baby.

Sadly, it is not possible to save the pregnancy if it becomes ectopic. It will have to be removed using medicine or an operation.

According to the NHS, in the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year.

What are the signs and symptoms?

There are some signs for an ectopic pregnancy, with most women developing symptoms between the fourth and twelfth week of pregnancy. However, some women don’t report any signs or symptoms at all - meaning an ectopic pregnancy may only be detected during a routine scan.

The NHS says that symptoms which do occur include:

• tummy pain low down on one side
• vaginal bleeding or a brown watery discharge
• pain in the tip of your shoulder
• discomfort when peeing or pooing

Professor Knight highlighted that in some cases of ectopic pregnancies, bleeding was attributed to miscarriage. In other cases, pregnant women who have collapsed from their symptoms were first investigated for a blood clot - the other major cause of maternal collapse - before an ectopic pregnancy was looked into.

One of the dangers of this, she explained, is that “the treatment for the two [blood clots or ectopic pregnancy] are diametrically opposite. If you think someone has a blood clot you give them a blood thinner. But if you’re bleeding internally, it will make you bleed more.”

Where can I find help and support after an ectopic pregnancy?

If you are struggling with grief or trauma after losing a pregnancy, there is help and support available. Some places to turn to include:

• The Ectopic Pregnancy Trust
• Ectopic Pregnancy Foundation
• Miscarriage Association
• Cruse Bereavement Care

The NHS writes on its website: “Losing a pregnancy can be devastating, and many women feel the same sense of grief as if they had lost a family member or partner.

“It’s not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.

“If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your GP about this.”