When Does Ectopic Pregnancy Bleeding Start?

Key points about ectopic pregnancy –

Pregnancy that develops outside the uterus is called ectopic pregnancy. Women with an ectopic pregnancy may have irregular bleeding and pelvic or abdominal pain, often on one side. Symptoms most often appear 6 to 8 weeks after the last normal menstrual period. Ectopic pregnancy may be treated in several ways, depending on whether the fallopian tube has burst. Don’t ignore symptoms of ectopic pregnancy. Call your healthcare provider if you have any bleeding or pain in pregnancy.

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Do you always bleed with an ectopic pregnancy?

How will I know if I have an ectopic pregnancy? – It is difficult to diagnose an ectopic pregnancy without a healthcare provider and some tests. Ectopic pregnancies often seem like typical pregnancies. A missed period and signs of pregnancy like tender breasts or nausea are common (2).

1. Most people with an ectopic pregnancy will have some light vaginal bleeding or spotting (3).
2. Abdominal pain and cramping on one side of the abdomen can be symptoms of an ectopic pregnancy (2).
3. It’s also possible to have an ectopic pregnancy without any vaginal bleeding or pain (3).
4. So, how can you know if you have an ectopic pregnancy? Some healthcare providers recommend an early first-trimester ultrasound to see where the pregnancy is located (1).

If you are pregnant, talk to your healthcare provider to see if this is right for you. If you are pregnant and have any vaginal bleeding with abdominal pain, check with your healthcare provider as soon as possible. They need to determine if your pregnancy is ectopic, if something else is going on, or if your experiences are typical during the first trimester (2).

• If the pregnancy is ectopic, an ultrasound, blood tests, and a check-up will help your healthcare provider decide which treatments to offer you (1).
• Ectopic pregnancies need treatment because as a tubal ectopic pregnancy grows, there is a risk of rupture in the fallopian tube.
• This is called a ruptured ectopic, and is a life-threatening emergency.

If you are pregnant or could be pregnant and experience sudden abdominal pain, shoulder pain, or weakness, these can be symptoms of a rupture and you should seek healthcare immediately (2).
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What does bleeding look like with ectopic pregnancy?

Early signs – The most common early signs and symptoms of an ectopic pregnancy include: ref2 ref3 ref4

• Lower stomach pain. Ectopic pregnancy pain is often located on one side of the body
• Vaginal bleeding, which may be dark, watery and heavier, lighter or more prolonged than a normal period
• Pregnancy symptoms such as a missed menstrual period, breast tenderness, frequent urination or nausea

However, it is possible to have an ectopic pregnancy without any of the above symptoms.
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What week of pregnancy is ectopic likely to rupture?

Topic Resources Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes.

In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy ruptures, women often have abdominal pain and vaginal bleeding, which, if not treated, can be fatal. Doctors base the diagnosis on results of blood tests and ultrasonography, done mainly to determine the location of the fetus. Usually, surgery is done to remove the fetus and placenta, but sometimes one or more doses of methotrexate can be used to end the ectopic pregnancy.

Pregnancy complications, such as ectopic pregnancy, are problems that occur only during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. Most pregnancy complications can be effectively treated.

In ectopic pregnancy, the fetus cannot survive, and if not diagnosed and treated promptly, ectopic pregnancy can cause life-threatening bleeding in the woman. Normally, an egg is fertilized in the fallopian tube and becomes implanted in the uterus. However, if the tube is narrowed or blocked, the fertilized egg may never reach the uterus.

Sometimes the fertilized egg then implants in tissues outside of the uterus, resulting in an ectopic pregnancy. Ectopic pregnancies usually develop in one of the fallopian tubes (as a tubal pregnancy) but may develop in other locations. A fetus in an ectopic pregnancy sometimes survives for several weeks.

However, because tissues outside the uterus cannot provide the necessary blood supply and support, ultimately the fetus does not survive. The structure containing the fetus typically ruptures after about 6 to 16 weeks, long before the fetus is able to live on its own. When an ectopic pregnancy ruptures, bleeding may be severe and even threaten the life of the woman.

The later the structure ruptures, the worse the blood loss, and the higher the risk of death. However, if an ectopic pregnancy is treated before it ruptures, the woman rarely dies. About two of 100 pregnancies are an ectopic pregnancy. Risk factors (conditions that increase the risk of a disorder) that particularly increase the risk for an ectopic pregnancy include

A previous ectopic pregnancy Fallopian tube abnormalities

Pregnancy is less likely to occur after tubal ligation is done or when an IUD is in place (fewer than 1.5% of women become pregnant). However, if pregnancy does occur, about 5% of them are ectopic. Other risk factors for ectopic pregnancy include
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How long after an ectopic Do you bleed for?

It is common to have mild vaginal bleeding for up to two weeks after your operation.
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What does the beginning of an ectopic pregnancy feel like?

Early warning of ectopic pregnancy – Often, the first warning signs of an ectopic pregnancy are light vaginal bleeding and pelvic pain. If blood leaks from the fallopian tube, you may feel shoulder pain or an urge to have a bowel movement. Your specific symptoms depend on where the blood collects and which nerves are irritated.
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How do you rule out an ectopic pregnancy?

Blood tests – Blood tests to measure the pregnancy hormone human chorionic gonadotropin (hCG) may also be carried out twice, 48 hours apart, to see how the level changes over time. This can be a useful way of identifying ectopic pregnancies that aren’t found during an ultrasound scan, as the level of hCG tends to be lower and rise more slowly over time than in a normal pregnancy.
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What color is ectopic pregnancy spotting?

Ectopic pregnancy – In rare cases, brownish-pink discharge can be caused by an ectopic pregnancy, This is when a pregnancy occurs outside of the uterus, most commonly in the fallopian tube, The brownish color occurs because the bleeding is older blood, not bright red (new) blood.

extreme dizziness shoulder pain fainting lightheadedness abdominal or pelvic pain that comes and goes, especially on one side

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Is ectopic pregnancy pain constant?

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.
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At what hCG level do ectopic pregnancies rupture?

Use of β human chorionic gonadotropin measurement – It is important to confirm pregnancy. In the emergency department, pregnancy is diagnosed by determining the urine or serum concentration of β human chorionic gonadotropin (β-hCG). This hormone is detectable in urine and blood as early as 1 week before an expected menstrual period.

Serum testing detects levels as low as 5 IU/L, whereas urine testing detects levels as low as 20–50 IU/L.22 In most cases, screening is done with a urine test, since obtaining the results of a serum test is time-consuming and is not always possible in the evening and at night. However, if pregnancy is strongly suspected, even when the urine test has a negative result, serum testing will be definitive.

A single serum measurement of the β-hCG concentration, however, cannot identify the location of the gestational sac. Although women with an ectopic pregnancy tend to have lower β-hCG levels than those with an intrauterine pregnancy, there is considerable overlap ( Table 2 ).23, 24 Table 2 If a low serum β-hCG level (< 1000 IU/L) is associated with a higher relative risk of ectopic pregnancy, then can very low levels predict a benign clinical course? In general, no. Although a single very low serum level (< 100 IU/L) has been felt to be reassuring, in a review of 716 admitted patients with ectopic pregnancy, 29% of those with such a level were found to have tubal rupture at laparoscopy.25 The risk of tubal rupture was similar across a wide range of β-hCG values. Another study identified 38 instances of rupture among women with serum levels ranging from 10 to 189 720 IU/L.7 Thus, a single serum β-hCG measurement cannot exclude ectopic pregnancy or predict the risk of rupture unless it is less than 5 IU/L. Serial β-hCG measurement is often used for women with first-trimester bleeding or pain, or both, but, as with a single measurement, serial measurement cannot confirm the location of the gestational sac. In a normal pregnancy, the first-trimester β-hCG concentration rapidly increases, doubling about every 2 days. An increase over 48 hours of at least 66% has been used as a cutoff point for viability.20, 26, 27 Ectopic pregnancy may present with rising, falling or plateau β-hCG levels; thus, serial measurement is most useful to confirm fetal viability rather than to identify ectopic pregnancy. In a patient with a subnormal increase in β-hCG concentration, nonviability is assumed, and more invasive investigations can be used to clarify the nature of the abnormality (i.e., miscarriage v. ectopic pregnancy). However, over-reliance on the doubling time may result in the interruption of a normal pregnancy through diagnostic dilatation and curettage (D&C) or administration of methotrexate. A recent study identified patients with only a 53% increase in serum β-hCG levels over 2 days who had a viable intrauterine pregnancy.28 Thus, demonstration of normal doubling of serum levels over 48 hours supports a diagnosis of fetal viability but does not rule out ectopic pregnancy, and a rising β-hCG concentration that fails to reach 50% suggests a failing or ectopic pregnancy, as does a plateau. Falling levels confirm nonviability but do not rule out ectopic pregnancy. View complete answer

Can you rule out ectopic at 5 weeks?

How Is an Ectopic Pregnancy Diagnosed? – If a woman might have an ectopic pregnancy, her doctor may do an ultrasound to see where the developing fetus is. Often, pregnancies are too small to see on ultrasound until more than 5 or 6 weeks after a woman’s last menstrual period.
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What are 3 causes of an ectopic pregnancy?

What causes an ectopic pregnancy? – The cause of an ectopic pregnancy isn’t always clear. In some cases, the following conditions have been linked with an ectopic pregnancy:

inflammation and scarring of the fallopian tubes from a previous medical condition, infection, or surgeryhormonal factorsgenetic abnormalitiesbirth defectsmedical conditions that affect the shape and condition of the fallopian tubes and reproductive organs

Your doctor may be able to give you more specific information about your condition.
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Do you get implantation bleeding with ectopic?

Ectopic Pregnancy – Bleeding can also occur during an ectopic pregnancy—when a fertilized ovum implants outside of the uterus. Symptoms of an ectopic pregnancy include:

Irregular bleedingCramps on one side of your body, ranging from mild to severe

These tend to occur six to eight weeks after your last period.
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Where does a ruptured ectopic pregnancy bleeding?

Bleeding from a ruptured ectopic pregnancy is usually intra-abdominal, not vaginal.
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What are the three classic symptoms of ectopic pregnancy?

History – The classic clinical triad of ectopic pregnancy is pain, amenorrhea, and vaginal bleeding; unfortunately, only about 50% of patients present with all 3 symptoms. About 40-50% of patients with an ectopic pregnancy present with vaginal bleeding, 50% have a palpable adnexal mass, and 75% may have abdominal tenderness.

In one case series of ectopic pregnancies, abdominal pain presented in 98.6% of patients, amenorrhea in 74.1% of them, and irregular vaginal bleeding in 56.4% of patients. These symptoms overlap with those of spontaneous abortion; a prospective, consecutive case series found no statistically significant differences in the presenting symptoms of patients with unruptured ectopic pregnancies versus those with intrauterine pregnancies.

In first-trimester symptomatic patients, pain as the presenting symptom is associated with an odds ratio of 1.42, and moderate to severe vaginal bleeding at presentation is associated with an odds ratio of 1.42 for ectopic pregnancy. In one study, 9% of patients with ectopic pregnancy presented with painless vaginal bleeding.

1. As a result, almost 50% of cases of ectopic pregnancy are not diagnosed at the first prenatal visit.
2. Patients may present with other symptoms common to early pregnancy, including nausea, breast fullness, fatigue, low abdominal pain, heavy cramping, shoulder pain, and recent dyspareunia.
3. Painful fetal movements (in the case of advanced abdominal pregnancy), dizziness or weakness, fever, flulike symptoms, vomiting, syncope, or cardiac arrest have also been reported.

Shoulder pain may be reflective of peritoneal irritation. Astute clinicians should have a high index of suspicion for ectopic pregnancy in any woman who presents with these symptoms and who presents with physical findings of pelvic tenderness, enlarged uterus, adnexal mass, or tenderness.
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How can you tell if you have an ectopic pregnancy at home?

Would an Ectopic Pregnancy Show Up on a Home Pregnancy Test? – Since ectopic pregnancies still produce the hormone hCG, they’ll register as a positive home pregnancy test. People with ectopic pregnancies will also experience early pregnancy symptoms like sore breasts, nausea, spotting, and more.
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Is ectopic pregnancy pain constant?

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.
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What percentage of ectopic pregnancies have bleeding?

In a retrospective study of 2026 pregnant patients who presented to the emergency department with first-trimester vaginal bleeding and/or abdominal pain, 376 ( 18 percent ) were diagnosed with ectopic pregnancy. Of these 376 patients, 76 percent had vaginal bleeding and 66 percent had abdominal pain.
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