Signs of an ectopic preg­nan­cy in the 5th week of preg­nan­cy

When pain or bleed­ing occurs in ear­ly preg­nan­cy, it can have many caus­es. One of these is an ectopic preg­nan­cy (tubal preg­nan­cy), in which the preg­nan­cy devel­ops out­side the uterus in the fal­lop­i­an tube. It should be detect­ed and treat­ed ear­ly, as it can lead to a rup­ture of the fal­lop­i­an tube and inter­nal bleed­ing as it pro­gress­es.

As a fer­til­i­ty cen­ter, we also sup­port women in the event of abnor­mal­i­ties in ear­ly preg­nan­cy and with ques­tions regard­ing fur­ther desire to have chil­dren. In this guide, we explain which signs can indi­cate an ectopic preg­nan­cy, how the diag­no­sis is made, how the ectopic preg­nan­cy is treat­ed, and what it means for a lat­er desire to have chil­dren.

• What is an ectopic preg­nan­cy?
• Typ­i­cal signs of an ectopic preg­nan­cy
• Preg­nant despite bleed­ing?
• Diag­nos­tics in ear­ly preg­nan­cy
• Treat­ment of an ectopic preg­nan­cy
• When is a new preg­nan­cy pos­si­ble again?
• Fre­quent­ly asked ques­tions about ectopic preg­nan­cy

What is an ectopic preg­nan­cy?

In an ectopic preg­nan­cy, the fer­til­ized egg does not implant in the uter­ine cav­i­ty, but in the fal­lop­i­an tube. It is thus the most com­mon form of a so-called extrauter­ine preg­nan­cy, i.e., a preg­nan­cy out­side the uterus. Ectopic preg­nan­cies account for about 1–2% of all preg­nan­cies.

The risk may be increased in women with:

• A pre­vi­ous ectopic preg­nan­cy
• Pre­vi­ous inflam­ma­tion in the pelvic area
• Endometrio­sis
• Pre­vi­ous chlamy­dia infec­tions
• Pre­vi­ous sur­gi­cal inter­ven­tions
• Smok­ing

How­ev­er, many ectopic preg­nan­cies also occur with­out known risk fac­tors.

After a pre­vi­ous ectopic preg­nan­cy, the risk of recur­rence for anoth­er ectopic preg­nan­cy is increased. The mag­ni­tude is stat­ed to be about 7–10%; nev­er­the­less, the prob­a­bil­i­ty that a nor­mal preg­nan­cy will occur in the uterus dur­ing a sub­se­quent preg­nan­cy is sig­nif­i­cant­ly high­er.

After sev­er­al pre­vi­ous ectopic preg­nan­cies, the risk increas­es sig­nif­i­cant­ly fur­ther and can be about 25–30% or more after two ectopic preg­nan­cies.

Symp­toms

Typ­i­cal symp­toms and first signs (5th to 7th week of preg­nan­cy)

An ectopic preg­nan­cy can ini­tial­ly pro­ceed entire­ly with­out symp­toms. Symp­toms often only appear dur­ing the course of ear­ly preg­nan­cy and can vary great­ly in sever­i­ty.

Pos­si­ble signs include:

• One-sided or increas­ing low­er abdom­i­nal pain
• Spot­ting or unusu­al vagi­nal bleed­ing
• Dizzi­ness, weak­ness, or cir­cu­la­to­ry prob­lems
• Pain dur­ing bow­el move­ments or uri­na­tion can also occur

One should be par­tic­u­lar­ly atten­tive to the com­bi­na­tion of a pos­i­tive preg­nan­cy test, pain, and bleed­ing.

Impor­tant: If an ectopic preg­nan­cy is sus­pect­ed, a gyne­co­log­i­cal eval­u­a­tion should be car­ried out prompt­ly. In the event of severe pain or cir­cu­la­to­ry prob­lems, imme­di­ate med­ical eval­u­a­tion is nec­es­sary.

The fol­low­ing applies: “Even if an ectopic preg­nan­cy is only sus­pect­ed, a prompt eval­u­a­tion is always very impor­tant.”

Preg­nant despite bleed­ing? Why a peri­od is not an all-clear sig­nal

Bleed­ing can also occur in ear­ly preg­nan­cy. It can have very dif­fer­ent caus­es and can­not be reli­ably cat­e­go­rized based on col­or or inten­si­ty alone.

Pos­si­ble caus­es include, for exam­ple:

• Bleed­ing in a healthy, intact ear­ly preg­nan­cy
• A small hematoma
• Con­tact bleed­ing, for exam­ple after sex­u­al inter­course
• An impend­ing mis­car­riage
• An ectopic preg­nan­cy

Bleed­ing can also occur with an ectopic preg­nan­cy and be mis­tak­en for men­stru­a­tion.

Our advice: If you have a pos­i­tive preg­nan­cy test and bleed­ing or pain occurs at the same time, you should seek med­ical advice quick­ly.

Diag­nos­tics in ear­ly preg­nan­cy – when to see a doc­tor?

Treat­ment of an ectopic preg­nan­cy

Treat­ment depends on your indi­vid­ual sit­u­a­tion, the symp­toms, the ultra­sound find­ings, and the pro­gres­sion of the preg­nan­cy hor­mone hCG.

Expec­tant man­age­ment
In the case of very ear­ly, sta­ble find­ings and already declin­ing hCG, close mon­i­tor­ing can be car­ried out in select­ed cas­es to see if the preg­nan­cy regress­es on its own.

Med­ical treat­ment with methotrex­ate
In the case of a reli­ably diag­nosed, non-rup­tured ectopic preg­nan­cy, methotrex­ate can be used under cer­tain con­di­tions. The med­ica­tion inhibits the fur­ther devel­op­ment of the preg­nan­cy tis­sue. Sub­se­quent­ly, reg­u­lar hCG checks are nec­es­sary.

Sur­gi­cal treat­ment
Surgery is nec­es­sary, in par­tic­u­lar, in the event of severe pain, cir­cu­la­to­ry insta­bil­i­ty, sus­pi­cion of a rup­ture, or cer­tain ultra­sound find­ings. If pos­si­ble, the pro­ce­dure is per­formed min­i­mal­ly inva­sive­ly as part of a laparoscopy.

Well-sup­port­ed for a renewed desire to have chil­dren

After an ectopic preg­nan­cy, ques­tions often arise regard­ing fur­ther fam­i­ly plan­ning and a pos­si­ble new preg­nan­cy. In our fer­til­i­ty cen­ter, we take the time to cat­e­go­rize and dis­cuss your his­to­ry and exist­ing find­ings and to deter­mine which exam­i­na­tions or next steps may be use­ful.

Our expe­ri­enced fer­til­i­ty doc­tors will advise you in an under­stand­able and per­son­al man­ner – with a view to your med­ical sit­u­a­tion and your ques­tions.