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Everything You Need to Know About an Ultrasound for Ectopic Pregnancy

Updated on: September 5, 2024 | PocketHealth
An ultrasound technician performing an abdominal scan on a woman

An ultrasound is one of the key methods to distinguish whether a pregnancy is ectopic. If a doctor refers you for an ultrasound for a suspected ectopic pregnancy, you’ll probably have questions and concerns. This article will explain ectopic pregnancy, including:

  • Signs, symptoms and risks of ectopic pregnancy
  • How an ectopic pregnancy is detected
  • The role of ultrasound in diagnosing ectopic pregnancy
  • How to prepare for your ultrasound
  • How to access and interpret your results

 

Get early access to your ultrasound reports

 

Ectopic pregnancy overview

Unpredictable and not fully understood, ectopic pregnancies can be very dangerous to the bearer’s health. Learn how an ectopic pregnancy is diagnosed.

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy which implants anywhere outside the uterus. Most ectopic pregnancies occur in the fallopian tubes, though in rare cases they can implant elsewhere.

Ectopic pregnancies are not viable, nor can they be moved to the uterus. They can cause intense pain and severe damage if left untreated. If there is a chance of a potential ectopic pregnancy, an ultrasound scan will be ordered.

Most patients discover whether they have an ectopic pregnancy between the fifth and tenth week of pregnancy. The first signs begin to appear two weeks after a missed period.

Signs and symptoms associated with an ectopic pregnancy

A woman holding her stomach

In the earliest weeks, an ectopic pregnancy might present with the same symptoms as a regular pregnancy, including sore breasts, fatigue and nausea. Patients may notice a change somewhere between weeks 5-10.

Not all ectopic pregnancies share the same symptoms, but common experiences include:

  • Bleeding: Unexpected vaginal bleeding, especially if it is different (brighter, darker, heavier or more watery) than usual.
  • Cramping: Some people report regular cramping, a sensation similar to but not quite the same as menstrual cramping. It might have a different locus in the body.
  • Dizziness/fainting/lightheadedness: If accompanied by excessive sweating and/or nausea, these can be an early sign of ectopic pregnancy.
  • Pain: Ectopic pregnancies often cause pain on one side of the abdomen or pelvis. The pain may be minimal at first, then increase in intensity. It also tends to spread. Unexplained shoulder pain can also be a symptom, especially if it hurts more when lying down.

How is ectopic pregnancy detected?

Doctors diagnose ectopic pregnancies with a blood test, a pelvic exam and an ultrasound scan. Often all of these methods are used together.

  • Blood test: The first step is to have a blood test, to confirm pregnancy. The test measures human chorionic gonadotropin (hCG) blood level.
  • Pelvic exam: During a pelvic exam, the doctor will palpate the abdomen and pelvic region to check for pain, sensitivity or tenderness. The doctor might also find signs of fluid build-up or other swelling.
  • Transvaginal ultrasound: In a transvaginal ultrasound, the technician inserts the transducer wand into the vaginal canal to capture images of the reproductive cavity. Early in a pregnancy, a transvaginal ultrasound can pick up much more detail than a transabdominal ultrasound.
  • Transabdominal ultrasound: A transabdominal ultrasound is taken by running the transducer over the skin of the abdomen. It can provide a broader perspective of the entire pelvic region, which may help to locate any internal bleeding.

How early can an ectopic pregnancy be detected by ultrasound?

Ultrasounds can typically identify an ectopic pregnancy during the first trimester (e.g. before 13 weeks), though it can happen earlier. The gestational sac becomes visible at 4.5-5 weeks and large embryos can be seen as early as 6 weeks.

Can an ectopic pregnancy be missed on an ultrasound?

Ultrasounds can identify more than 70% of ectopic pregnancies but depending on the size and placement of the embryo, it is possible to miss an ectopic pregnancy on an ultrasound. If the ultrasound cannot confirm an ectopic pregnancy, laparoscopic surgery might be required. Laparoscopic procedures are day surgeries in which tiny incisions are made to insert a small tube (laparoscope) so doctors can directly view the affected areas.

 

What do ectopic pregnancies look like on ultrasound scans?

The sonographer will be scanning for the signs and structures or early pregnancy, such as:

  • A thickening of the endometrium (the lining of the uterus)
  • Blood or tissue buildup
  • A decidual cast (extra, sloughed-off portion of the endometrium)
  • An empty uterus despite high hCG levels
  • A gestational sac (a dark, fluid filled sac surrounding the embryo)
  • Fluid buildup in the abdominal or peritoneal cavity
  • A yolk sac (embryonic nutrition sac that is absorbed by the embryo during the first trimester)
  • The embryo (called a fetal pole in the earliest stages of pregnancy)

Ectopic pregnancies occur most frequently in the fallopian tubes. 95% of all ectopic pregnancies are either ampullary (in the middle of the fallopian tube), fimbrial (at the far end) or isthmic (at the uterine end). 3% are interstitial, e.g. located where the tube passes into the uterus.

Much more rarely, an ectopic pregnancy might be located elsewhere, such as:

  • In abnormally shaped uterus (cornual)
  • The abdomen (abdominal)
  • The cervix (cervical)
  • The muscle of the uterus (intramural)
  • The ovaries (ovarian)
  • Scar tissue (e.g. a Caesarian scar)

A heterotopic pregnancy consists of two simultaneous pregnancies implanted at different sites. One is usually viably implanted in the uterus while the other is ectopic.

Ectopic Pregnancy in the interstitial portion of the Fallopian tube

Ectopic Pregnancy in the interstitial portion of the Fallopian tube (Image credit: Ultrasound Care)

Preparing for your ultrasound

Understanding what will happen during an ectopic pregnancy ultrasound can help assuage any anxiety. The following steps can help patients be ready:

  • Bring a copy of your requisition: Your requisition has important information for the imaging clinic.
  • Know which type of ultrasound you’ll receive: Check beforehand if the clinic has any special preparation recommendations.
  • Drink lots of water the week before: Good hydration produces better images.
  • Arrive with a full bladder: Soundwaves travel well through liquid.
  • Wear loose and comfortable clothes: You’ll need to change into a hospital gown.
  • Bring a support person: You may not be able to have someone with you in the exam room (each imaging clinic will have its own rules) but having someone with you before and after can be a comfort.

What to expect during your scan

Pregnancy ultrasounds are safe, low risk, pain-free imaging techniques. To capture internal images, the technician moves a sound wave-producing transducer through conductive gel. The sound waves bounce off internal structures and tissues and the ‘echoes’ are compiled into real-time images.

A transvaginal ultrasound can be uncomfortable, but it should not be painful. An ultrasound for an ectopic pregnancy typically takes 20-45 minutes. It does not require extensive preparation and after the scan you can go about your day as normal.

The sonographer is not legally allowed to answer questions about ultrasound results but is free to discuss the procedure itself. You can ask:

  • Can I have someone with me during the exam?
  • What can my support person do during the scan?
  • How long will this appointment last?
  • When will I receive your results?

When will I get my results?

A woman looking at her pregnancy ultrasound report on PocketHealth

A woman looking at her pregnancy ultrasound on PocketHealth

The technician sends the ultrasound images to a radiologist for examination and analysis. The radiologist forwards a report and the images to your doctor, who discusses them with you at a follow-up appointment. The process usually takes several days.

With PocketHealth, you can have secure access to your ultrasound results before that follow-up appointment – often as soon as they are released by the radiologist.

 

Get early access to your medical imaging reports

 

Understanding my results

Navigating your ultrasound doesn’t have to be confusing. This section will help you understand who analyzes your images and what they might mean.

Who interprets the results?

Although you can have early access to your results with PocketHealth, it’s very important to follow-up with your referring physician. A radiologist will study and interpret your ultrasound images, then create a report describing the results. Your referring physician will share and discuss those results with you.

With early access to your ultrasound results, you can ask more informed questions, such as:

  • What are the signs of ectopic pregnancy?
  • What other changes or symptoms will I notice?
  • How often do I need to get an ultrasound with ectopic pregnancy?
  • How do we proceed from here? What are the next steps?

MyCare Navigator, which highlights any recommendations contained in your report, will also create a list of customized questions to help steer your discussion with your doctor.

How do I make sense of my results?

Ultrasound images are captured in shades of black, white and gray. The different shades represent the density of the tissue the sound waves encounter. The densest structures, like bone, are white, while the least dense, such a fluid, are black. The images have a cone-like shape, with the narrowest end of the cone being the top of the image.

Your ultrasound report will be full of specific terminology. If you have any difficulty understanding it, Report Reader provides an easy-to-understand definition of medical terms. However, it’s important to understand that while PocketHealth educates and empowers patients, it is not a replacement for professional medical advice.

For more detail, please see our page about how to understand your ultrasound results.

 

Stay on top of your pregnancy journey with PocketHealth

Discovering you have an ectopic pregnancy can be difficult. The symptoms can be painful and the consequences severe. As you search for a diagnosis, PocketHealth can help you keep track of your pregnancy reports and ultrasounds. The more you understand about your condition, the more prepared and proactive you can be.

 

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