Ectopic Pregnancy in Tropical Africa: Causes, Symptoms and Treatment 

Author: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). Medically reviewed by the DLHA Team

A healthcare professional in blue scrubs performing an ultrasound scan on a woman. Ai Image from ChatGpt

 

Highlights

• An ectopic pregnancy occurs when a fertilised egg grows outside the womb, most often in the fallopian tube.

• Risk factors include past ectopic pregnancy, pelvic infections, surgeries, infertility treatments, and smoking.

• Early symptoms may be light vaginal bleeding, abdominal pain, or dizziness, but rupture can cause severe bleeding and collapse.

• Diagnosis is made through clinical assessment and diagnostic tests such as, pregnancy tests, ultrasound scans, and sometimes laparoscopy.

• Treatments range from careful monitoring and medication (like methotrexate) to surgery, depending on the situation.

• Early detection and prompt care can save fertility and prevent life-threatening complications.

 

Introduction

 What Is an Ectopic Pregnancy?

The joy of a positive pregnancy test is beyond measure, especially if the pregnancy was desired. This joy can turn sour if the pregnancy is found to be abnormal. It is even worse if the doctor explains that the condition may lead to loss of a reproductive organ or even life if not treated promptly.

An ectopic pregnancy occurs when the fertilised egg is implanted (attached) outside the uterine cavity (womb), most commonly in the fallopian tube. 

Ectopic pregnancy is one of the abnormalities of pregnancy, and the diagnosis is usually associated with distress because of the complications linked to it. In some cases, the complications can be life-threatening, especially when rupture occurs. Early diagnosis and intervention are needed to prevent organ loss or a threat to life.

How Common is Ectopic Pregnancy in Africa?

Rates of ectopic pregnancy in Lagos, Nigeria. Click on image to enlarge. Data source

 

Ectopic pregnancy happens in about 1-2 out of every 100 pregnancies in the United States. A study in Lagos, Nigeria, found that ectopic pregnancy occurred in about 2 out of every 100 deliveries and caused death in about 1 out of every 100 cases.

In rare situations, an ectopic pregnancy can occur alongside a normal pregnancy. This condition is called a heterotopic pregnancy. It is seen in about 1 in 30,000 pregnancies, but the chances increase with assisted reproductive techniques.

This article discusses the locations, methods of diagnosis, and treatment options for ectopic pregnancy in Africa.

 

Where Ectopic Pregnancy Can Occur in the Body

Fig. 1: Illustration of the female reproductive anatomy showing possible locations of an ectopic pregnancy. Click on iage to enlarge.

 

The most common location is the fallopian tube (see fig 1). This occurs in about  95%  of cases. [1, 2]

Other sites include:

• The ovary
• The cornua (upper corners of the uterine (womb) muscle)
• The cervix (the mouth of the womb)
• The abdomen
• Cesarean section scar
  
   

Who Is at Risk of Ectopic Pregnancy?

Ectopic pregnancy can occur without any risk factors; however, some factors can increase the risk (see fig. 2). [3, 4]

Fig. 2: Illustration of some risk factors of ectopic pregnancy. Click on image to enlarge

 

Your risk may be higher if you:

• Have had a previous ectopic pregnancy. The more ectopic pregnancies you’ve had, the greater your risk
• Have a history of pelvic infections and multiple sexual partners
• Have a history of prior abortion(s) - usually unsafe
• Have had surgery on your fallopian tube, such as tubal ligation (tying of your tubes)
• Have undergone previous surgeries, including a cesarean section
• Have had infertility treatment, especially those involving assisted reproductive technology
• Have undergone previous surgeries, including a cesarean section
• Have had infertility treatment, especially those involving assisted reproductive technology
• Are older than 35 years
• Have endometriosis, which can distort the pelvic structures
• Were born with an abnormality in the structure of your reproductive organs
• Use an intrauterine device (IUD). While an IUD lowers your overall risk of pregnancy, if you do get pregnant with it in place, the chance of it being ectopic is higher
• Use some progesterone-only birth control pills, which may slightly increase your risk
• Smoke

A study in Accra, Ghana, showed that starting sex early in life, multiple partners, and previous evacuation of the womb also increase risk [3].

Related: 

Pelvic Inflammatory Disease in Africa: Causes and Symptoms

Tips on Safe Sex Practice for African Adolescents and Young Adults

The risk factors for ectopic pregnancy in locations outside the fallopian tube are not yet fully understood, but they may be related to some of these factors as well.

 

How Does Ectopic Pregnancy Occur?

For ectopic pregnancies that happen in the fallopian tube, the risk factors increase the chances of the event by: [1]

• Affecting how the fallopian tubes contract
• Blocking or narrowing the fallopian tubes
• Altering the structure of pelvic organs

The fallopian tubes are delicate, tube-like structures on both sides of the womb. This is the place where the sperm meets the egg and fertilisation occurs. They are made up of smooth muscles that contract rhythmically to help move the fertilised egg. They also have cilia, which are tiny, hair-like structures that sweep the egg towards the womb for implantation (attachment).

When the inner lining of the tube (epithelium) or cilia are damaged, often due to infection or previous surgery, the fertilised egg may fail to move properly. A blockage in the tube can also stop the egg’s journey. In such cases, the embryo may implant within the tube, leading to a tubal ectopic pregnancy. The most common site of attachment in the tube is the ampulla (the widest part of the fallopian tube)

In addition, if the smooth muscle contractions are reduced, the transport of the fertilised egg slows down, which can also result in attachment of the embryo to the tube.

As the pregnancy grows inside the fallopian tube, the tube may eventually burst (rupture), leading to bleeding. This usually happens between 6 and 16 weeks of pregnancy, depending on the part of the tube where the pregnancy is attached.

For ectopic pregnancies that occur outside the fallopian tube, the exact mechanisms are less clear. For instance, in rare cases of abdominal pregnancy, it is believed that the fertilised egg may be expelled from the open end of the tube (a process known as tubal abortion) and then attach to organs in the abdominal cavity.

 

Common Symptoms of Ectopic Pregnancy

The common symptoms of ectopic pregnancy are shown in Table 1.

Table 1: listing the symptoms of non-ruptured and ruptured ectopic pregnancies. Click on the image to enlarge.

 

If the ectopic pregnancy is unruptured, it may not cause symptoms, and you may only notice signs of early pregnancy.  However, scanty vaginal bleeding may occur at this stage. 

Major bleeding often occurs inside the abdomen when an ectopic pregnancy in the fallopian tube ruptures, and you may then experience any of these: [1, 2]

• Pain in the lower abdomen (mild bleeding) or all over the abdomen ( if there is massive bleeding)
• Abdominal swelling
• Dizziness or fainting
• Shoulder tip pain
• Nausea or vomiting
• Problems with urination or defecation

Related: Pregnancy: Symptoms, Test, Types, Stages, Complications, Care and More

 

How Is Ectopic Pregnancy Diagnosed?

Diagnosis involves: [3]

• Clinical history and physical examination (body checks)
• Ultrasound scan
• Blood/urine tests

History:

If you have an ectopic pregnancy, you may have missed your period and have one or more symptoms.

To arrive at the diagnosis, your doctor will ask about your symptoms and risk factors.

Examination: 

Your doctor will check:

• Your general state
• Blood pressure
• Pulse rate
• Whether you are pale
• Your abdomen for pain or swelling
• Your pelvis for bleeding, and the state of your womb and surrounding structures

Tests:

• Pregnancy test: Urine or blood may be used. This test detects the presence of the pregnancy hormone, β-hCG, in your blood or urine. The test is usually positive.

• Ultrasound scan: A transvaginal scan (through the vagina) is the best way to confirm the diagnosis. A transabdominal scan may also be done, especially if abdominal bleeding is suspected. Sometimes your doctor may diagnose it accidentally while doing an early pregnancy scan. This is why an early pregnancy scan is recommended.

• Quantitative β-hCG: This measures the exact amount of the pregnancy hormone in the blood. It is used when diagnosis is difficult with a regular pregnancy test and an ultrasound scan. If the level of β-hCG is greater than 1500-2000 mIU/ml and a transvaginal scan does not show a pregnancy inside the womb, the pregnancy is likely to be ectopic.

If you have a ruptured ectopic pregnancy, you may present in shock. Your doctor will quickly diagnose it with an ultrasound scan and rush you to surgery.

Ectopic pregnancies in other sites are more difficult to diagnose. This is because the signs and symptoms are not always clear [5].  If the ultrasound scan does not give a definite answer, doctors may carry out:

• Laparoscopy: a keyhole surgery done with tiny cuts and a camera
• Exploratory laparotomy: open surgery with a larger cut on the abdomen

These two procedures are used to diagnose and treat the condition.
 

Diseases that may Mimic Ectopic Pregnancy

Sometimes, other conditions can look very similar to an ectopic pregnancy and may confuse the diagnosis. [1]. 

Fig, 3: Some conditions that can be confused with ectopic pregnancy. Click on image to enlarge.

 These include: (fig. 3)

• Pelvic inflammatory disease (pelvic infection)
• Tubo-ovarian abscess
• Appendicitis
• Ovarian torsion (when the ovary twists, cutting off its blood supply)
• Ureteral calculi (stones in the ureter)

 

How is an Ectopic Pregnancy Treated? 

The treatment of ectopic pregnancy depends on several factors, including: [1, 2, 4]

• The site of the ectopic pregnancy
• Whether it has ruptured or not
• Your intention for future pregnancy
• Whether you are in good health (stable) or poor health(unstable) at the time of diagnosis
• The overall health of your fallopian tubes and reproductive system

Options include:

•  Expectant (watchful)management
• Medical treatment
• Surgical treatment

Expectant (watchful) management

This is considered only in rare cases, especially if the hCG level is less than 200miu/ml and continues to decline. In this case, your condition and hCG levels are closely monitored by your doctor. No medication is given.

Medical treatment

This involves the use of drugs to treat the ectopic pregnancy. The most common drug is methotrexate. This is a drug which stops cell growth in the developing pregnancy. It is usually given as an injection into the muscle in one dose, two doses, or multiple doses [4].

Your doctor will consider using methotrexate if:

• You are in good health(stable)
• Have an unruptured ectopic pregnancy
• No heartbeat seen on scan
• HCG level is less than 5000 mIU/ml
• The pregnancy sac is less than 4 cm
• You have normal blood count, kidney, and liver function tests
• You have no allergy to methotrexate
• You have no active peptic ulcer
• You are ready to comply with regular monitoring

Monitoring may take days and weeks and includes checking of:

• Symptoms
• Vital signs (Blood pressure and pulse)
• HCG levels
• Ultrasound scan

If methotrexate treatment fails, surgery may be needed.

If methotrexate is not suitable, Actinomycin D may be used, though with more side effects [4]. 

In some cases, methotrexate or potassium chloride may be injected directly into the tube alongside surgery.

Surgical treatment

Surgical treatment involves the treatment of the disease with surgery (operation)

Options include:

• Laparoscopy: minimally invasive surgery using a camera and instruments through small holes in the abdomen. This is suitable if you are in good health (stable).

• Exploratory laparotomy: open surgery with a large cut, often needed if you are unstable (e.g., ruptured ectopic).

Types of surgery on the tube:

• Salpingostomy: a small cut is made on the fallopian tube to remove the pregnancy, and left open to heal. It is used when the ectopic is unruptured, the other tube is damaged, and you desire to have more babies.

• Salpingotomy: This is almost the same as salpingostomy, but the cut on the tube is stitched.

• Interval salpingectomy: the affected tube segment is removed, and the ends are joined later in another surgery.

• Salpingectomy: Part of the affected tube or the entire tube is removed. This is often done if rupture has occurred.

A study in Ghana showed that more than 7 out of 10 women came to the hospital after the ectopic pregnancy had already ruptured. This is why, in many parts of Africa, most ectopic pregnancies are treated with salpingectomy.

For ectopic pregnancies in other sites, treatment depends on the location and may involve medical or specialised surgical methods [5]. 

 

When to See a Doctor

If you are in early pregnancy or unsure if you are pregnant and develop severe abdominal pain, fainting, or bleeding, call emergency services and see your doctor immediately.

 

Conclusion

Ectopic pregnancy is an abnormal outcome of pregnancy. In many cases, it requires surgery. Early diagnosis can prevent rupture and help preserve fertility and prevent massive bleeding.  With advances in diagnosis, death rates have reduced. If you miss your cycle, see your doctor for an early scan to help detect and diagnose ectopic pregnancy promptly.

 

Frequently Asked Questions (FAQs)

Can I get pregnant after an ectopic pregnancy?

Yes. Many women go on to have successful pregnancies. Fertility depends on the health of the remaining reproductive organs. Because the risk of recurrence is higher, early ultrasound in the next pregnancy is advised.

Can ectopic pregnancy be prevented?

Not always. However, preventing and treating sexually transmitted infections and stopping smoking can help reduce the risk.

 

References:

1. Vadakekut ES, Gnugnoli DM. Ectopic pregnancy. [Updated 2025 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [Cited 2025 Sep 11]. Available from here.

2. Asah-Opoku K, Oppong SA, Ameme DK, Nuamah MA, Mumuni K, Yeboah AO, et al. Risk factors for ectopic pregnancy among pregnant women attending a tertiary healthcare facility in Accra, Ghana. Int J Gynaecol Obstet. 2019 Oct;147(1):120–5. Available from here.

3. Hendriks E, Rosenberg R, Prine L. Ectopic pregnancy: diagnosis and management. Am Fam Physician. 2020;101(10):599-606. Available from here.

 4. Mullany K, Minneci M, Monjazeb R, C Coiado O. Overview of ectopic pregnancy diagnosis, management, and innovation. Women's Health (Lond). 2023 Jan-Dec;19:17455057231160349. doi: 10.1177/17455057231160349. Available from here. 

5. Sokalska A, Rambhatla A, Dudley C, Bhagavath B. Nontubal ectopic pregnancies: overview of diagnosis and treatment. Fertil Steril. 2023 Sep;120(3 Pt 2):553–62. Available from here.

 

More related resources:

Common Causes of Miscarriage in Nigerian Women

How To Determine Your Fertile Window For Pregnancy

What Africans Need To Know About The Pregnancy Test and Kit

How to Improve Reproductive Health Wellbeing: Advice for African Adults

 

 

Published: October 12, 2025

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