The positive pregnancy test brings relief and excitement. Then, days or weeks later, something feels wrong. An ache on one side of the abdomen. Light bleeding that does not seem like a normal period. A dizzy spell. A sudden, severe pain that takes the breath away.
For some women in Chennai, what began as what appeared to be a normal early pregnancy is an ectopic pregnancy, a fertilised egg that has implanted outside the uterus. It is a condition that cannot continue to develop, cannot be moved to the uterus, and must be treated promptly before it becomes a life-threatening emergency.
Understanding the ectopic pregnancy cause, who is at highest risk among women in Chennai, what the warning signs are, and exactly when a gynaecologist must be seen urgently is information that every woman of reproductive age deserves to have.
What Is an Ectopic Pregnancy?
In a normal pregnancy, a fertilised egg travels along the fallopian tube and implants in the lining of the uterus, where it develops over the next nine months. In an ectopic pregnancy, the fertilised egg implants somewhere outside the uterus.
In approximately 95% of cases, the implantation occurs in the fallopian tube, most commonly in the ampullary region of the tube. A 2025 Indian tertiary care observational study found that ampullary implantation accounted for 82.1% of cases. Less commonly, ectopic pregnancies occur in the ovary, the cervix, a caesarean section scar, or in the abdominal cavity.
A fallopian tube cannot expand or support a developing pregnancy the way the uterus can. As the ectopic pregnancy grows, it stretches the tube. Left untreated, the tube ruptures. The resulting internal bleeding is rapid, severe, and life-threatening.
An ectopic pregnancy cannot be moved to the uterus and cannot result in a live birth. Treatment is always required.
What Causes Ectopic Pregnancy?
The common thread across most ectopic pregnancy causes is anything that slows or obstructs the fertilised egg's journey along the fallopian tube, preventing it from reaching the uterus in the first few days after fertilisation.
Pelvic Inflammatory Disease and Tubal Damage
Pelvic inflammatory disease is one of the most consistent and significant ectopic pregnancy causes identified in Indian studies. Previous pregnancy loss emerged as the predominant risk factor in the 2025 Indian study, followed by pelvic inflammatory disease in 17.9% of cases.
PID is an infection of the uterus, fallopian tubes, and surrounding structures, most commonly caused by sexually transmitted infections including Chlamydia trachomatis and Neisseria gonorrhoeae. Untreated or inadequately treated PID causes inflammation and scarring within the fallopian tube lumen. This scarring narrows the tube, creates a rough inner surface, or disrupts the cilia that sweep the fertilised egg toward the uterus. The result is that the egg becomes lodged in the tube.
Some experts believe that up to half of all ectopic pregnancies are related to Chlamydia infection. A significant proportion of Chlamydia infections produce no obvious symptoms, meaning a woman may have experienced PID without ever knowing it.
Previous Ectopic Pregnancy
A history of a prior ectopic pregnancy is one of the strongest risk factors for a subsequent one. The underlying tubal damage that contributed to the first ectopic pregnancy, whether from infection, surgery, or anatomical factors, remains present after treatment. The risk of recurrence is meaningful and warrants closer early pregnancy monitoring in any subsequent pregnancy.
Previous Pelvic or Abdominal Surgery
Any surgery involving the pelvis, fallopian tubes, or abdomen can produce adhesions, bands of scar tissue that form between structures during the healing process. Surgery that increases ectopic pregnancy risk includes:
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Previous fallopian tube surgery, including surgery for a prior ectopic pregnancy
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Caesarean section
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Appendectomy
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Surgery for endometriosis
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Ovarian cyst removal
Adhesions from these procedures can distort the path of the fallopian tube, narrow its lumen, or reduce the mobility that allows the egg to travel smoothly.
Endometriosis
Endometriosis, where tissue similar to the uterine lining grows outside the uterus, can affect the fallopian tubes directly, causing inflammation, adhesions, and structural damage that elevates ectopic pregnancy risk. Women with endometriosis have higher rates of ectopic pregnancy than the general population.
IUCD Use
A woman who becomes pregnant while using an intrauterine contraceptive device has an elevated relative risk of that pregnancy being ectopic. An IUCD is very effective at preventing intrauterine pregnancy but provides less protection against tubal implantation. This does not mean that IUCD use directly causes ectopic pregnancy, but that when conception occurs despite an IUCD, the probability of ectopic location is higher.
Assisted Reproductive Technology
Women who conceive through IVF or IUI have a higher incidence of ectopic pregnancy compared to spontaneous conception. This relates in part to the underlying tubal conditions that led to the need for fertility treatment. Despite embryo transfer directly into the uterine cavity during IVF, a small proportion of embryos migrate into the fallopian tube and implant there.
Smoking
Tobacco smoking has been identified as an independent risk factor for ectopic pregnancy. Smoking impairs the movement of cilia in the fallopian tubes and alters tubal motility, reducing the tube's ability to propel the fertilised egg toward the uterus.
Hormonal Factors
Progesterone plays a role in fallopian tube motility and the cilia function that moves the egg along. Hormonal imbalances, including those associated with PCOS, can affect this mechanism. Progestogen-only contraceptive pills, when they fail, are associated with a higher proportion of ectopic pregnancies among the resulting conceptions, because these hormones slow tubal motility.
Who Is at Highest Risk Among Women in Chennai?
The Indian data consistently identifies specific risk factor profiles that are directly relevant to Chennai's patient population.
A 2025 Cureus Indian hospital study found that the most frequent risk factors for ectopic pregnancy in their cohort were previous pregnancy loss (19.5% of cases) and pelvic inflammatory disease (17.9%). The majority of patients were aged 26 to 35 years, from the lower and middle socioeconomic groups, and a significant proportion were referral cases presenting from other facilities.
For women in Chennai, the risk factors most clinically relevant include:
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A history of PID or sexually transmitted infections, including those that may have been asymptomatic
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Previous caesarean section, which is performed at high rates across Tamil Nadu
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Endometriosis, which is common but underdiagnosed in Indian women
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Prior pelvic surgery including appendectomy or ovarian cyst management
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Previous ectopic pregnancy
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Current or previous IUCD use
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Difficulty conceiving naturally (which may reflect underlying tubal compromise)
A woman with any of these factors who has a positive pregnancy test should have an early transvaginal ultrasound and serial beta-hCG measurements to confirm that the pregnancy is intrauterine before routine antenatal care begins.
Symptoms of Ectopic Pregnancy
This section is critically important because the classic symptom triad of ectopic pregnancy, abdominal pain, missed period, and vaginal bleeding, is present in only 30% to 40% of patients. Many women do not recognise they are pregnant, or attribute early symptoms to an irregular period or minor abdominal discomfort.
Early Symptoms (Before Rupture)
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A missed or late period, though some women continue to have light bleeding and do not realise they are pregnant
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A positive home pregnancy test
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One-sided abdominal or pelvic pain, dull, aching, or cramping
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Light vaginal bleeding or spotting that is different from a normal period
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Nausea, particularly if accompanied by abdominal discomfort
These symptoms are easily attributed to an early intrauterine pregnancy, a threatened miscarriage, or menstrual irregularity. Any woman with a positive pregnancy test and one-sided abdominal pain should have an urgent gynaecological assessment to exclude an ectopic pregnancy.
Symptoms of a Rupturing Ectopic Pregnancy
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Sudden, severe, sharp abdominal or pelvic pain that may be one-sided but can become generalised
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Shoulder tip pain, felt at the top of the shoulder and caused by blood irritating the diaphragm from below. This is a specific and important symptom that patients
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frequently do not associate with an abdominal problem
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Dizziness, lightheadedness, or fainting
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Feeling faint when sitting or standing
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Rapid heart rate
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Pallor and cold, clammy skin
A rupturing ectopic pregnancy is a surgical emergency. It can cause massive internal haemorrhage within minutes. Any woman of reproductive age with sudden severe abdominal pain and shoulder tip pain, particularly if she has a positive or recently positive pregnancy test, must go to emergency care immediately.
How Ectopic Pregnancy Is Diagnosed
Early diagnosis before rupture is the most important clinical goal in ectopic pregnancy management. The diagnostic approach combines three elements:
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Transvaginal ultrasound (TVS): The most important investigation. A normal intrauterine pregnancy should be visible on TVS from approximately five to six weeks of gestation. If a positive pregnancy test result exists but no intrauterine pregnancy is seen on ultrasound, ectopic pregnancy must be actively excluded. A tubo-ovarian mass, free fluid in the pelvis, or a visible extrauterine gestational sac are positive findings for ectopic pregnancy. The most common ultrasonographic finding in the 2025 Indian observational study was a tubo-ovarian mass in 33.33% of cases.
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Serum beta-hCG: Serial beta-hCG measurements over 48 hours assess how the pregnancy is developing. In a normal intrauterine pregnancy, beta-hCG typically rises by at least 53% every 48 hours. An abnormally rising or plateauing hCG alongside an empty uterus on ultrasound strongly suggests ectopic pregnancy.
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Clinical assessment: Tenderness on pelvic examination, cervical motion tenderness, and adnexal mass on bimanual examination are clinical findings that support the diagnosis and guide urgency.
Treatment Options for Ectopic Pregnancy
Treatment is determined by the size and location of the ectopic pregnancy, the patient's clinical stability, and whether rupture has occurred.
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Expectant management: For very early, small, and declining ectopic pregnancies with falling beta-hCG levels, watchful waiting under close monitoring may be appropriate in selected cases. This requires reliable follow-up and an understanding of the signs of deterioration.
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Medical treatment with methotrexate: Methotrexate is a medication that stops the growth of the developing pregnancy tissue. It is given by injection and is appropriate for haemodynamically stable patients with a small, unruptured ectopic pregnancy, no fetal cardiac activity, and beta-hCG below a specified threshold. It avoids surgery but requires close follow-up with serial beta-hCG measurements.
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Surgical treatment: Surgery is required for ruptured ectopic pregnancies, for those that have failed medical management, and for those that are too large or in a location unsuitable for methotrexate. Laparoscopic surgery is the preferred approach and involves either salpingotomy (opening the tube to remove the pregnancy while preserving the tube) or salpingectomy (removal of the affected tube). Laparoscopic surgery results in faster recovery, less blood loss, and shorter hospital stay compared to open surgery.
In the 2025 Indian tertiary care study, rupture was found in 84.6% of cases at the time of surgery, indicating that most patients presented at an advanced stage. This underscores the importance of early recognition and consultation rather than waiting for symptoms to worsen.
When to See a Gynaecologist in Chennai
Seek prompt gynaecological assessment within 24 to 48 hours if:
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You have a positive pregnancy test and one-sided lower abdominal pain
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You have a positive pregnancy test and unusual vaginal bleeding
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You have a positive pregnancy test and any risk factors for ectopic pregnancy including prior ectopic pregnancy, tubal surgery, or PID
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Your beta-hCG levels are rising slowly or inconsistently after a positive pregnancy test
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An intrauterine pregnancy has not been confirmed on ultrasound despite a positive test
Go to emergency care immediately if:
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You have sudden severe abdominal or pelvic pain
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You have shoulder tip pain alongside abdominal symptoms
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You feel faint, dizzy, or like you might lose consciousness
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You have signs of shock including pallor, cold sweating, and rapid heart rate
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You have had a positive pregnancy test in the past weeks and develop any sudden worsening of symptoms
Expert Gynaecological Care at Humayun Hospital, T Nagar
At Humayun Hospital, T Nagar, Chennai, Dr. Asma Humayun, Gynaecologist and Obstetrician, provides specialist assessment and management for women with suspected or confirmed ectopic pregnancy.
Dr. Asma Humayun holds MBBS, DGO (Sri Ramachandra University), Fellowship in Assisted Reproductive Techniques (F.ART), Fellowship in Minimal Access Surgery (F.MAS), Diploma in Reproductive Medicine from Germany, and MRCOG from the UK. Her F.MAS qualification means she is specifically trained in laparoscopic surgical techniques including laparoscopic management of ectopic pregnancy, the gold standard surgical approach that offers the best outcomes and fastest recovery.
We provide:
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Early pregnancy transvaginal ultrasound and serial beta-hCG monitoring for women with risk factors or symptoms
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Prompt assessment for any woman with a positive pregnancy test and abdominal symptoms
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Medical management with methotrexate for eligible cases
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Laparoscopic surgical management for cases requiring surgery
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Counselling and fertility follow-up for women who wish to conceive in the future after ectopic pregnancy treatment
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Emergency gynaecological assessment for suspected ruptured ectopic pregnancy
For women in T Nagar and across Chennai who have a positive pregnancy test and any concern about its location, or who have any of the risk factors described in this guide, early assessment is not excessive caution. It is the clinical decision that changes outcomes.
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