Ectopic Pregnancy at 4 weeks: Signs, Symptoms, Causes, Treatment

An ectopic pregnancy happens when a fertilised egg implants outside the womb, usually in the fallopian tube, instead of inside the uterus where it should grow. Very rarely it can implant in the ovary, cervix, caesarean scar or abdomen.

At about 4 weeks, this pregnancy is still very small and may feel exactly like a normal early pregnancy, or there may be light bleeding, one-sided pain, or no symptoms at all. Many women with an ectopic pregnancy have no symptoms this early.

Ectopic pregnancy is dangerous because the tube can burst and cause internal bleeding, which is life-threatening. Early diagnosis and treatment can save your life and, in many cases, protect your chance of future pregnancy.

Some things increase the risk of ectopic pregnancy, like previous pelvic infections (especially chlamydia and gonorrhoea), a past ectopic pregnancy, smoking, fertility treatment, and surgery on the tubes or around the pelvis.

This article explains the signs of ectopic pregnancy at 4 weeks, possible causes, what to do, and danger signs that mean you must see a doctor urgently.

What are the symptoms and signs of ectopic pregnancy at 4 weeks?

If you are now four weeks pregnant, it’s common to get worried if you experience bleeding, back pain, body weakness, and abdominal cramping.

At four weeks pregnancy, you’ve just passed your expected period, and you may already be experiencing pregnancy symptoms by now.

Symptoms of pregnancy at four weeks pregnant will differ from woman to woman. However, body weakness, nausea, mild tummy cramps, food aversion and breast changes are common early symptoms.

Usually, at four weeks pregnant, your breast will feel tender to touch and may cause you feel severe discomfort when touched by your partner.

These symptoms can happen in early pregnancy, but they can also be caused by other things, so they do not prove you are pregnant on their own. A pregnancy test is still needed.

If you have an ectopic pregnancy, here are symptoms you may experience.

1. Vaginal bleeding

A lot of women that have an ectopic pregnancy will notice vaginal bleeding. Bleeding may come out dark in color and may be associated with pain in your lower abdomen or pelvis.

If you are four weeks pregnant and having vaginal bleeding, it’s important to talk to your doctor as soon as possible because sometimes it may be the earliest sign something is wrong with the pregnancy.

Having said that, some women will have an ectopic pregnancy without even bleeding. You may still have tummy pain, dizziness, shoulder tip pain, or sometimes almost no symptoms until the tube is about to rupture.

2. Abdominal pain

At four weeks, it’s not uncommon to feel pain once in a while. These cramps are usually mild.

If you are having a severe abdominal pain, especially on the right or left side of the abdomen, it could be an ectopic pregnancy. If you are bleeding too, it means something is wrong. Don’t wait, see your doctor immediately.

You should also go straight to the emergency room if you have severe pain with shoulder tip pain, feeling faint, fast heartbeat, or collapse. These can be signs of internal bleeding and are an emergency. Similar warning signs are listed by Mayo Clinic and Cleveland Clinic.

How is ectopic pregnancy diagnosed at 4 weeks pregnant?

If you are 4–5 weeks pregnant and experiencing cramp, talk to your doctor as quickly as you can. Your doctor will ask some questions; so make sure you are prepared.

Some questions are

• When did you notice the pain and on which side?
• Is pain sharp or dull?
• Do you feel pain all the time or it comes and goes?
• Are you bleeding vaginally? If yes, any blood clots?
• Do you have back pain too?
• Are you feeling weak or dizzy?
• Any pain at your shoulder tip?

These questions quickly give your doctor the idea of how severe it is. For instance, if you are experiencing a shoulder tip pain, it may mean you are already bleeding into your abdomen and irritating your diaphragm, which needs urgent care.

Quickly, a transvaginal ultrasound and human chorionic gonadotropin (HCG) blood test will be checked.

During pregnancy, and in the first trimester, women will continue to produce HCG. In many normal early pregnancies the level rises by about 50–100% every 48 hours, but there is a wide normal range.

If your doctor does not locate a pregnancy within your womb (at around five weeks) when your HCG level is above the local “discriminatory zone”, this raises concern for an ectopic pregnancy or a pregnancy of unknown location. In this situation, serial HCG tests and repeat ultrasound scans are usually needed before a final diagnosis is made, so that a normal early pregnancy is not ended by mistake. Professional guidelines such as the NICE guideline on ectopic pregnancy and miscarriage (NICE NG126) describe this approach for doctors.

Immediately after a diagnosis, treatment is dependent on how clinically stable you are.

Women in early stages of an ectopic pregnancy without any rupture or heavy internal bleeding may be treated with methotrexate injection. This medicine stops the pregnancy cells growing so that the body can absorb them, and it requires regular blood tests until the HCG level becomes negative.

On the other hand, quick action is needed if you are bleeding or the tube has ruptured, and a salpingectomy (removal of the affected tube) or salpingotomy (opening the tube to remove the pregnancy) is carried out. This is usually done with keyhole (laparoscopic) surgery, but sometimes open surgery is needed in an emergency.

What causes ectopic pregnancy at 4 weeks?

If you’ve now been diagnosed with an ectopic pregnancy, perhaps you are wondering how you got here in the first place. Here are the reasons you probably had an ectopic.

Untreated vaginal infection for a long time

If you’ve always had chlamydia, gonorrhea, and trichomoniasis infection without taking steps to treat yourself, it could eventually harm your fallopian tubes and cause an ectopic pregnancy later in life. Chlamydia and gonorrhea are the two leading causes of pelvic inflammatory disease (PID).

Failed intrauterine device

Intrauterine devices are used to prevent pregnancy. If an IUD fails and you become pregnant with it still in place, you have a higher chance that the pregnancy will be ectopic compared with women who conceived without an IUD, although most pregnancies with an IUD are still in the womb.

Previous ectopic pregnancy

If you were told in one of your previous pregnancies that you had an ectopic, it becomes possible, and more likely, to get another. However, many women will still go on to have a normal pregnancy in the uterus afterwards.

Previous tubal ligation or surgery

Surgery at your fallopian tubes may disrupt its lumen and can increase your risk of an ectopic pregnancy. A reversal after tying up your tubes may also increase the risk of an ectopic pregnancy.

Sometimes, no clear cause is found. Even women with no risk factors at all can develop an ectopic pregnancy.

What steps to take after an ectopic pregnancy at 4–5 weeks?

First of all, it’s difficult to deal with the reality of losing your baby through an ectopic. You will need all emotional support from people around you to feel better, and it can help to talk with your doctor, counsellor, or a support group.

Secondly, you should know there is a chance you could get an ectopic pregnancy again, therefore talking to an O/G doctor is vital to improve the safety of your next pregnancy. In your next pregnancy you may be advised to come early for blood tests and a transvaginal scan to confirm that the pregnancy is inside the uterus.

Finally, you are still able to get pregnant, so don’t stop trying unless your doctor has advised otherwise. It is usually important to wait for a while (often at least 3 months, especially if you received methotrexate) before trying again, so that your body and folate levels can recover.

Good luck.