An emergency first. A fertility question after.

An ectopic pregnancy is a pregnancy that implants outside the womb, most often in a fallopian tube, and it cannot continue.

Normally the fertilised egg travels down the tube and implants in the womb lining. If the tube is damaged or slow, it can implant in the tube instead. Rarely it implants in the ovary, cervix or a caesarean scar. The RCOG says about 1 in 90 pregnancies in the UK is ectopic. If you are reading this after losing a pregnancy, we are sorry. What follows is practical, for when you are ready.

The usual signs of an ectopic pregnancy are pain low in the tummy, often on one side, and vaginal bleeding or brown discharge, usually between 4 and 12 weeks.

Some women have no symptoms until a scan finds it. Shoulder-tip pain, dizziness, fainting or feeling very unwell can mean the tube has burst and is bleeding inside. That is an emergency: call 108 or go to the nearest emergency department.

Most ectopic pregnancies happen because a fallopian tube is damaged, so the embryo gets held up on its way to the womb.

Tube damage comes from past pelvic infection, earlier tube or pelvic surgery, endometriosis or a previous ectopic. Smoking and getting pregnant with a coil in place raise the risk. IVF lowers the risk from the tubes but does not remove it. Often no cause is found, and nothing you did caused it.

Ectopic pregnancy is found with a transvaginal scan and repeated hCG blood tests, and treated by monitoring, a methotrexate injection, or keyhole surgery.

If you are well and the hormone level is low and falling, careful monitoring may be enough. If it is small with no heartbeat and you have little pain, a methotrexate injection can stop it growing. If there is more pain, a larger mass, a heartbeat or bleeding inside, keyhole surgery removes the pregnancy, usually with the affected tube. The hospital team decides with you.

Yes, most women can get pregnant after an ectopic pregnancy, naturally with one healthy tube, or with IVF if both tubes are damaged or removed.

Removing the affected tube is not thought to lower your chance of getting pregnant again, if the other tube is healthy. The risk of another ectopic is higher than before, so a tube test before trying can help. If the remaining tube is damaged, IVF avoids relying on it.

After methotrexate, wait at least 3 months before trying; after surgery, you can try once you have recovered, usually after 4 to 6 weeks, and when you both feel ready.

Methotrexate can harm a developing baby, so use reliable contraception for those 3 months. In your next pregnancy, have a scan at about 6 weeks to confirm it is in the womb. If you have had more than one ectopic, or the other tube is damaged, talk to us before trying.