Ectopic Pregnancy in Black Women: Warning Signs to Know

An ectopic pregnancy is a pregnancy that implants outside the uterus, almost always in a fallopian tube. It cannot survive, and as it grows it can rupture the tube and cause life-threatening internal bleeding. Black women are diagnosed with ectopic pregnancy more often than white women, and they die from it at far higher rates. The two facts that protect you are the same for everyone: recognize the warning signs early, and demand a pregnancy test and an ultrasound when something feels wrong.

After an egg is fertilized, it normally travels down the fallopian tube and implants in the lining of the uterus, where there is room to grow. In an ectopic pregnancy, the fertilized egg implants somewhere else. About 97% of the time that place is a fallopian tube, which is why ectopic pregnancies are often called tubal pregnancies. A tube is narrow and cannot stretch to hold a growing pregnancy. As the pregnancy enlarges it can split the tube open, a rupture, which causes rapid internal bleeding. There is no way to move the pregnancy into the uterus and no way for it to survive outside the uterus. Treatment is about protecting the pregnant person's life and fertility.

The gap shows up at both ends: Black women get ectopic pregnancies more often, and they survive them less often. In a study of more than 14 states' Medicaid data, the ectopic pregnancy rate was 46% higher for Black women than white women (relative risk 1.46). A separate analysis of an insured California health system from 2010 to 2019 found ectopic pregnancy in 21.9 of every 1,000 pregnancies among Black women versus 14.6 per 1,000 among white women. The mortality gap is the part that should make every reader pay attention. From 2003 to 2007, the ectopic pregnancy death rate was 6.8 times higher for Black women than white women. Ectopic rupture is a leading cause of first-trimester pregnancy-related death, and it kills Black women at a rate that no other group faces.

The main driver is damage to the fallopian tubes. Scarred or narrowed tubes trap a fertilized egg before it reaches the uterus. The most common cause of that scarring is pelvic inflammatory disease (PID), an infection that usually starts as untreated chlamydia or gonorrhea. Black women carry a heavier burden of both. The lifetime rate of PID among Black women is 2.2 times that of white women (6.0% versus 2.7%) even among women with no diagnosed prior infection, which points to gaps in screening and treatment, not behavior. Each episode of PID raises the odds that a future pregnancy lands in a damaged tube. If you have had chlamydia, gonorrhea, or PID, tell every clinician who treats you in early pregnancy. Learn the symptoms in our guide to pelvic inflammatory disease in Black women.

Tubal damage is not the only risk factor. Your odds of an ectopic pregnancy go up if you have had one before, have had tubal surgery or a tubal ligation, smoke, conceive through in vitro fertilization, or become pregnant while using an intrauterine device. None of these guarantee an ectopic pregnancy. They are reasons to be evaluated quickly the moment you have a positive test and any pain or bleeding.

Early symptoms can look like a normal pregnancy or a miscarriage, which is part of why ectopic pregnancies get missed. The signal to act on is pain that is sharp, stabbing, or concentrated on one side of the lower belly or pelvis, often paired with vaginal bleeding or spotting. Three symptoms point to a possible rupture and internal bleeding: pain at the tip of one shoulder (blood under the diaphragm irritates a nerve), sudden dizziness or lightheadedness, and fainting. A rupture is a surgical emergency. People bleed to death internally from ruptured ectopic pregnancies, and the bleeding is not always visible from the outside.

Ectopic pregnancy is dangerous partly because it hides. Early on it can mimic a urinary infection, an ovarian cyst, or a normal early pregnancy. It is more dangerous when pain is not taken seriously. Research has documented that Black patients' pain is underestimated and undertreated across emergency and obstetric settings, and that Black women are less likely to receive tube-sparing surgery for ectopic pregnancy (relative risk 0.76 compared with white women). You do not have to accept being sent home unexamined. If you have a positive or possible positive pregnancy test and pain or bleeding, say the words out loud: I need a pregnancy test, an hCG blood level, and a transvaginal ultrasound to rule out an ectopic pregnancy. Bring someone with you if you can. Write down your last period date and any history of STIs, PID, or prior ectopic pregnancy.

Diagnosis rests on two tools used together. A transvaginal ultrasound looks for a pregnancy inside the uterus; if the uterus is empty but a blood test confirms pregnancy, an ectopic is suspected. Doctors also measure the pregnancy hormone hCG in the blood, often twice over 48 hours, because in a healthy early pregnancy that number rises in a predictable pattern. An abnormal rise plus an empty uterus points toward an ectopic pregnancy.

Treatment depends on how early and how stable you are. If the pregnancy is caught early, has not ruptured, and your vital signs are stable, a medication called methotrexate can stop the pregnancy from growing so your body reabsorbs it, with no surgery. You will need repeat blood tests afterward to confirm the hCG falls to zero. If the pregnancy is larger, if methotrexate is not an option, or if you choose surgery, a surgeon removes the ectopic pregnancy, sometimes saving the tube and sometimes removing it. If the tube has already ruptured, it is emergency surgery to stop the bleeding. The faster an ectopic pregnancy is found, the more options you have and the more likely your tube is preserved.

One ectopic pregnancy does not mean you cannot carry a pregnancy later. Many people go on to have healthy pregnancies, including after losing one fallopian tube, because the remaining tube can do the work. A prior ectopic pregnancy does raise the risk of another one, so future pregnancies should be confirmed early with an ultrasound to check that the pregnancy is in the uterus. Tell your clinician about your history at the first positive test, not at your first prenatal visit weeks later.

If you are pregnant or could be, build your care around providers who listen. A clinician who takes your pain seriously and orders the right tests early is the single biggest protection against a missed ectopic pregnancy. You can find a Black or Black-serving OB-GYN or reproductive-health provider in our directory. If you have a history of STIs, PID, tubal surgery, or a prior ectopic pregnancy, say so at your first positive test and ask for an early ultrasound to confirm the pregnancy is in the uterus.