What are the symptoms of an ectopic pregnancy and when is it medical negligence?

Certain factors increase a woman’s risk. These include a previous ectopic pregnancy, pelvic inflammatory disease, surgery to the fallopian tubes, infertility or fertility treatment, endometriosis, a history of sexually transmitted infections, use of an intrauterine device (IUD) at the time of conception, and tobacco smoking. However, it is important to note that ectopic pregnancy can still occur in women with no identifiable risk factors. The NICE guidelines advise that a third of ectopic pregnancies happen in women with no risk factors.

Diagnosis typically involves a combination of investigations, including pregnancy testing (urine and blood tests) and ultrasound scanning, most often a transvaginal ultrasound. Despite this, symptoms such as pain and bleeding are sometimes misattributed to other conditions, such as urinary tract infections, miscarriage, gastrointestinal problems, or appendicitis. In some cases, relevant medical history may not be fully considered, or test results may be misinterpreted, leading to dangerous delays in diagnosis.

National guidance from NICE (Ectopic Pregnancy and Miscarriage, NG126) highlights a maternal mortality rate of 0.2 per 1,000 ectopic pregnancies and notes that approximately two thirds of deaths are associated with substandard care.

They emphasise that healthcare professionals should consider ectopic pregnancy whenever a woman of reproductive age presents with abdominal pain, pelvic pain or vaginal bleeding. Appropriate investigation and referral are essential because early diagnosis greatly reduces the risk of serious complications.

When ectopic pregnancy is suspected, urgent action is critical. Women with significant pain, bleeding, or signs of collapse should be referred immediately to hospital. Those with a positive pregnancy test and abdominal or pelvic tenderness should be urgently assessed by specialist early pregnancy or gynaecology services. Delays in referral, failure to carry out appropriate investigations, or misdiagnosis can have devastating consequences.

Most ectopic pregnancies should be identified during early ultrasound assessment., and professional standards expect the majority to be diagnosed at the first scan. Where the diagnosis is uncertain, close monitoring and follow-up are essential. Rupture most commonly occurs between six and ten weeks of pregnancy and can lead to emergency surgery, loss of fertility, long-term injury, or, in the most severe cases, death.

Treatment options include expectant management (close monitoring), medication (Methotrexate to stop the pregnancy growing), or surgery (laparoscopic removal of the ectopic pregnancy, often with the affected fallopian tube). The most appropriate option depends on how far along the pregnancy is, hormone levels, (hCG in blood) and the severity of symptoms. Immediate treatment—usually surgery—may be required to prevent life-threatening complications. All of the options have pros and cons and need to be appropriately discussed with the patient.

Most healthcare professionals provide excellent care, and diagnosing the condition can sometimes be challenging because the symptoms often resemble those of other conditions. However, there are occasions where opportunities to identify an ectopic pregnancy are missed, resulting in delays to diagnosis and treatment.

In our experience, delays can occur for several reasons, including:

• A pregnancy test not being carried out when someone presents with abdominal pain, vaginal bleeding or other symptoms in early pregnancy.
• Failing to consider ectopic pregnancy as a possible diagnosis, despite symptoms or relevant risk factors.
• Not arranging an urgent ultrasound scan or appropriate follow-up where the diagnosis remains uncertain.
• Symptoms being incorrectly attributed to another condition, such as miscarriage, a urinary tract infection, appendicitis or a gastrointestinal illness.
• A patient being discharged without appropriate safety-netting advice about when to seek urgent medical attention if their symptoms worsen.
• Scan findings, blood test results or other clinical information not being recognised or acted upon appropriately.

If you’ve experienced a delayed diagnosis, you may be left wondering whether anything could have been done differently. While not every delay is the result of medical negligence, where accepted standards of care have not been followed and this has led to avoidable harm, it may be appropriate to seek specialist legal advice.

A delayed diagnosis does not automatically mean medical negligence occurred. However, our specialist maternal injury compensation claims team can help assess whether care fell below an acceptable standard and whether those failures contributed to the harm you’ve suffered. In our experience, delays in diagnosis often occur when the symptoms are misinterpreted or overlooked and often misdiagnosed as miscarriage, when the actual location of the pregnancy has not been confirmed.

Read our guide to medical negligence claims & compensation

Support and awareness are also crucial.

Recovering after an ectopic pregnancy can be physically and emotionally challenging. Alongside medical care, many people benefit from specialist support. The Ectopic Pregnancy Trust provides helpful information, peer support, virtual groups and practical advice for patients and their families.

As specialist maternal injury solicitors, we have supported many women and families affected by delayed diagnosis of ectopic pregnancy.

Aimee’s story illustrates how we help clients who have experienced late diagnosis of ectopic pregnancy to claim compensation.

Aimee’s case

Aimee’s case highlights the serious consequences of a delayed ectopic pregnancy diagnosis. Despite raising concerns and seeking medical advice, she was incorrectly reassured, leading to a missed opportunity for early treatment.

This delay resulted in a rupture of her fallopian tube and emergency surgery—an outcome that could have been avoided with appropriate care. We successfully secured a sum in compensation to reflect both her physical and psychological trauma.

Click here to read the full case study. 

Six‑figure compensation for fatal ectopic pregnancy misdiagnosis

RWK Goodman acted for the estate of a woman who died as a result of a ruptured ectopic pregnancy.

The deceased lady advised both her GP and midwifery services that she was experiencing brown vaginal bleeding and abdominal pain alongside a positive pregnancy test.  These are well recognised warning sides of ectopic pregnancy, but the symptoms were not investigated.

In February 2018, the woman advised her husband that she was feeling incredibly unwell with severe abdominal pain, vomiting and feeling cold.  Her husband contacted maternity services but was advised to telephone 111.  There was a significant delay in answering his call and utilising a translator service.  The call was then incorrectly categorised leading to a delay in dispatching an ambulance.

The deceased’s condition rapidly deteriorated whilst awaiting medical assistance and, despite a further call to 999 and category 1 ambulance then being dispatched, the woman died with her death being witnessed by both her husband and young child.  A post-mortem examination confirmed a ruptured ectopic pregnancy and massive internal bleeding with the cause of death being noted as hypovolaemic shock.

RWK Goodman assisted in relation to both the inquest and clinical negligence case.  As a result of RWK Goodman’s involvement, changes were made to the 111 call protocols.

The clinical negligence claim settled against the Ambulance Trust who were responsible for the 111 Service on the basis that if the call had been correctly triaged, the ambulance would have arrived earlier and, on the balance of probabilities, the deceased would have been transferred to hospital and surgery undertaken prior to her death.

The claim settled for a six-figure sum.

GP failure to suspect ectopic pregnancy resulted in a delay diagnosis

We settled a claim for our client who had been a victim of negligence following a delay by her GP to suspect that she was suffering from an ectopic pregnancy. Our client began experiencing dull pelvic pain with intermittent sharp twinges on her right side, as well as fatigue, loss of appetite, and out-of-cycle bleeding, which was unusual for her. She took multiple at-home pregnancy tests, all of which showed faint positive lines and booked an emergency appointment with her GP later that same day. 

During the GP appointment, our client reported irregular bleeding, pelvic discomfort, and a faint positive pregnancy test. The GP suggested that the bleeding was likely a result of the emergency contraception she had taken the month before and advised a follow-up in a week if the bleeding didn’t settle. Our client felt dismissed by the GP, as her pain and bleeding continued without any further explanation or investigation. 

About 1 week later, our client experienced a sudden onset of severe pain in her right side, radiating down her right thigh, and was unable to walk. She attended hospital where an ultrasound scan revealed she had an ectopic pregnancy. She had to undergo emergency surgery to remove the pregnancy and her fallopian tube. 

We instructed an expert to assess the standard of care our client received from her GP and this concluded that there was a clear obligation to consider and rule out an ectopic pregnancy, which was entirely disregarded despite several positive pregnancy tests carried out by the Claimant. The Claimant reported sharp pelvic and abdominal pain, as well as ongoing bleeding, both of which are commonly associated with an ectopic pregnancy. Her GP should have referred her for assessment at the local Early Pregnancy Unit. 

With earlier diagnosis it is likely that our client would have avoided the loss of her fallopian tube. Though our expert evidence confirmed that the loss of the fallopian tube was unlikely to affect her long term fertility, £10,000 was recovered for our client to represent the pain and suffering that arose from the negligence.