The signs are severe one-sided abdominal pain (usually between 6 and 8 weeks), dark vaginal bleeding, shoulder pain, dizziness, pallor or a rapid heartbeat, and beta-hCG rising slowly. If you suspect an ectopic pregnancy, do not wait for your next appointment: go straight to an emergency room with gynecology services. It occurs in about 2% of pregnancies and is a medical emergency.
If you suspect one, do not wait for your next scheduled appointment. An ectopic can progress to tubal rupture with internal bleeding within hours. Go straight to an emergency room with gynecology services.
The book's short rule: one-sided pain + bleeding = ectopic until proven otherwise. Shoulder pain with any bleeding is also on its list of reasons to go straight to the ER. For anything less clear, call your doctor: one extra call is better than one call too late.
Fertilization happens in the fallopian tube, and the embryo normally travels 5 to 7 days down to the uterus to implant. In an ectopic pregnancy it implants outside the uterus instead, most often in a fallopian tube. It occurs in about 2% of pregnancies, and the book calls it the biggest early concern.
In an ectopic pregnancy, beta-hCG can rise more slowly than the healthy pattern. That is why the book connects ectopic pregnancy to two things you may already be watching: a test that stays negative while your period doesn't come, and a serial beta-hCG that rises less than 35% in 48 hours.
Ectopic pregnancy is covered in Chapter 40 of Map to the Positive, in Station V (Positive), with the other first-trimester warning signs and a clear list of when to go straight to the ER. The book is the whole map from preparing to conceive through the first 30 days after a positive, including, in Station IV, when to see a specialist and the most common diagnoses. It is worth keeping, or giving to someone who is still trying.
Take 30 days. If it does not give you more clarity than everything you have read for free so far, ask for a refund and you get every cent back. We cannot promise you a pregnancy. We can promise you will not be guessing.
References: ESHRE Guideline on Ectopic Pregnancy, 2020.