A tubal, or ectopic, pregnancy occurs when a fertilized egg implants in one of the fallopian tubes rather than in the uterus. This is a serious condition that is fatal for the embryo and can be life threatening for the mother, especially if the tube ruptures and causes extensive bleeding. While some women experience many symptoms during early tubal pregnancy, others have no signs at all.
One of the most common signs of a tubal pregnancy is abdominal pain. Some women experience this pain all over the pelvis and abdomen, while for others it localizes on the side of the fallopian tube. Tubal pregnancies can also cause spotting or bleeding, which may be mistaken for a period if it occurs early in the ectopic pregnancy. If the tubal pregnancy ruptures and causes internal bleeding, it may cause severe pain, including pain in the shoulders, as well as fainting or signs of shock.
Most women who have symptoms of a tubal pregnancy start to notice them at about six weeks gestation. However, some women may start to get symptoms at about four weeks, which is often the time that many women would normally be expecting their periods. Tubal pregnancies may result in either positive or negative home pregnancy tests, which many women use a few days after missing a period, or in the case of early result tests, a few days before.
Doctors may use several methods to positively identify a tubal pregnancy. To start, they may use blood tests to determine the level of hCG, which is often called the pregnancy hormone, since the body starts producing it once implantation occurs. In a normal pregnancy, the levels of hCG rise dramatically as the pregnancy continues. During a tubal pregnancy or miscarriage, the hCG levels will not be as high as they should. Doctors may also do a physical or vaginal exam to check for an enlarged fallopian tube. An ultrasound can often detect fallopian tube swelling or bleeding more reliably.
In some cases, health care professionals may be able to see a developing embryo in the fallopian tube and confirm a tubal pregnancy. In many cases, however, the embryo dies shortly after implantation, making diagnosis more difficult. When doctors can't tell for sure if a tubal pregnancy has occurred, they may continue to examine a patient over a period of several days or weeks to see if the symptoms worsen or subside, as long as there is no evidence of severe bleeding or pain.
Any woman who has signs of a tubal pregnancy should contact her doctor right away, regardless of whether she has had a positive home pregnancy test. If the woman has signs of shock, such as dizziness, clammy skin or a very fast pulse, someone should call 911 or take her to an emergency room immediately. There may be signs of internal bleeding, which can be life threatening if not treated as soon as possible. Women who have a positive home pregnancy test but no signs of tubal pregnancy should still contact their health care providers as soon as possible to begin prenatal care, which will allow their doctors to check for any signs of tubal pregnancy.