Mengandung luar rahim (ectopic pregnancy) is when a fertilised egg grows outside the womb, usually in a fallopian tube. The pregnancy cannot continue, and if the tube splits open it can cause dangerous internal bleeding. Watch for pain low down on one side of the tummy, unusual vaginal bleeding or pain in the tip of the shoulder in early pregnancy, and get medical help quickly. This guide explains the tanda mengandung luar rahim, the emergency signs, causes and risk factors, how it is diagnosed and treated, and your chances of a healthy pregnancy afterwards.
Call 999 or go to the nearest hospital emergency department now if you might be pregnant and have sudden, sharp and intense tummy pain, feel very dizzy or faint, feel sick, or look very pale. These can be signs that the fallopian tube has ruptured.
Apa itu mengandung luar rahim (ectopic pregnancy)?
In a normal pregnancy, the fertilised egg moves along the fallopian tube into the womb, where it implants and grows. According to the NHS, an ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. The RCOG (Royal College of Obstetricians and Gynaecologists) says that rarely, in 3 to 5 out of 100 ectopic pregnancies, it grows in other places; Cleveland Clinic lists the ovary, the abdominal cavity and the cervix.
Cleveland Clinic explains that a fallopian tube cannot stretch like the womb. If the pregnancy keeps growing, it can split the tube open (rupture) and cause severe pain and internal bleeding. Sadly, the pregnancy cannot be saved: an egg outside the womb cannot develop into a baby, and it usually has to be removed with medicine or an operation.
How common is it? In the UK, around 1 in 90 pregnancies is ectopic, according to the NHS and the RCOG. Cleveland Clinic gives a figure of about 2% of all pregnancies.
In Malaysia. A 2022 study from Universiti Sains Malaysia notes that ectopic pregnancy was recorded as the fourth principal cause of maternal death in Malaysia in 2019. The researchers conclude that early diagnosis may reduce illness and death, which is why it matters to know the signs.
Tanda mengandung luar rahim: signs and symptoms
According to the NHS, symptoms tend to develop between the 4th and 12th week of pregnancy. The RCOG says most women get physical symptoms in the 6th week, about 2 weeks after a missed period. Some women have no symptoms at first, and the problem is only found on an early scan.
| Symptom | What it can be like |
|---|---|
| Missed period and signs of pregnancy | A positive pregnancy test with other early signs; see our guide to tanda-tanda mengandung |
| Tummy pain low down on one side | Can start suddenly or gradually, and may be constant or come and go (NHS) |
| Vaginal bleeding or brown watery discharge | Often different from a normal period: it may start and stop, and be watery and dark brown. Some women mistake it for a period (NHS) |
| Pain in the tip of the shoulder | An unusual pain where the shoulder ends and the arm begins. The NHS says it can be a sign of internal bleeding, so get medical advice right away |
| Discomfort when going to the toilet | Pain or pressure in the bottom when pooing, pain when peeing, or diarrhoea (NHS) |
These symptoms do not always mean something serious. The NHS notes that tummy pain and bowel changes can also be caused by a stomach bug, trapped wind or a urine infection, and the NHS says vaginal bleeding during pregnancy is relatively common and is not necessarily a sign of a serious problem, although you should still get medical advice. For bleeding that may be a miscarriage, see our guide to keguguran. For other causes of one-sided pain, see our guide to sakit perut.
When to get medical advice. The NHS advises seeing a doctor straight away if you have a combination of these symptoms and might be pregnant, even if you have not had a positive pregnancy test. The RCOG adds that if you have had sex in the last 3 or 4 months, even with contraception, you should seek help even if you do not think you could be pregnant. If your period is late, our guide to period lambat explains other possible causes.
Emergency signs: when to call 999
In a few cases, an ectopic pregnancy grows large enough to split open the fallopian tube. According to the NHS, signs of a rupture include a combination of:
- a sharp, sudden and intense pain in your tummy;
- feeling very dizzy or fainting;
- feeling sick;
- looking very pale.
This is an emergency: call 999 or go to the nearest hospital emergency department immediately. A rupture needs surgery as soon as possible. The NHS says a rupture can be life threatening, but ruptures are uncommon and treatable if dealt with quickly. The RCOG notes that in rare cases, collapse may be the very first sign of an ectopic pregnancy.
Punca dan faktor risiko (causes and risk factors)
In many cases, it is not clear why an ectopic pregnancy happens. The NHS says it sometimes happens when there is a problem with the fallopian tubes, such as them being narrow or blocked, so the egg cannot move along to the womb. The NHS, the RCOG and Cleveland Clinic list these risk factors:
- pelvic inflammatory disease (PID), an infection usually caused by a sexually transmitted infection (STI), which can damage the tubes;
- a previous ectopic pregnancy: the NHS puts the risk of another at around 10%;
- previous surgery on the fallopian tubes, including sterilisation (tubal ligation), or other pelvic surgery;
- fertility treatment such as IVF, or a history of infertility;
- becoming pregnant while using an IUD or IUS (coil). It is rare to get pregnant with these, but if you do, an ectopic pregnancy is more likely. The RCOG also lists becoming pregnant while taking the progestogen-only pill (mini pill);
- endometriosis (listed by Cleveland Clinic);
- smoking;
- age: the NHS says the risk is highest for pregnant women aged over 35.
Having a risk factor does not mean you will have an ectopic pregnancy, and not having one does not rule it out: Cleveland Clinic says up to 50% of women who have an ectopic pregnancy have none of these risk factors. If you find out you are pregnant and have an IUD in place, or have had your tubes tied, Cleveland Clinic advises contacting your doctor right away.
How an ectopic pregnancy is diagnosed
The NHS says it can be difficult to diagnose an ectopic pregnancy from symptoms alone, because they are similar to other conditions. The RCOG says most ectopic pregnancies are suspected between 6 and 10 weeks of pregnancy. Tests can include:
- a pregnancy test: the RCOG says that if it is negative, an ectopic pregnancy is very unlikely;
- a transvaginal ultrasound scan, where a small probe is gently placed in the vagina. The RCOG says this is more accurate than a scan through the tummy;
- blood tests for the pregnancy hormone hCG, usually repeated 48 hours apart. The RCOG explains that in a pregnancy in the womb the level rises by about 63% every 48 hours, while in an ectopic pregnancy it is usually lower and rises more slowly or stays the same;
- keyhole surgery (laparoscopy), if it is still not clear. If an ectopic pregnancy is found, it may be treated in the same operation.
Pregnancy of unknown location. Sometimes the pregnancy test is positive but the scan does not show where the pregnancy is. The RCOG explains that this may be a very early pregnancy in the womb that is too small to see, a miscarriage, or an ectopic pregnancy. You will usually have repeat blood tests and scans. The waiting can be stressful, but it helps doctors reach the right diagnosis before discussing treatment.
Rawatan: treatment options
Your doctor will recommend the most suitable option based on your symptoms, the size of the pregnancy, your hCG level and scan results, and your wishes about future pregnancy. According to the NHS and the RCOG, the main options are:
| Option | Who it may suit | What happens | Things to know |
|---|---|---|---|
| Expectant management (monitoring) | No or mild symptoms, and the pregnancy is very small or cannot be found | Regular blood tests until hCG is no longer found; you will usually have some bleeding and may have some tummy pain | The RCOG says success varies widely, from 30% to 100%, and is lower when hCG is higher; there is still a small risk of rupture |
| Medicine (methotrexate) | Diagnosed early, when monitoring is not suitable | A single injection that stops the pregnancy growing, then regular blood tests | The RCOG says 15 in 100 women need a second injection and 7 in 100 need surgery. Use reliable contraception for at least 3 months and avoid alcohol until told it is safe |
| Surgery (usually keyhole) | The NHS says keyhole surgery is used in most cases; emergency surgery is needed if the tube has ruptured | The pregnancy is removed, usually with the affected tube if the other tube looks healthy | The NHS says most women leave hospital a few days after surgery, but full recovery can take 4 to 6 weeks |
Results in Malaysia. A 10-year review of 73 women treated with methotrexate at a Malaysian tertiary referral hospital found that 87.7% were treated successfully: 76.7% needed only 1 dose and 11.0% needed a second dose. Smaller ectopic pregnancies were more likely to respond.
Removing the tube or keeping it? The RCOG says that if your other tube is healthy, you will usually be advised to have the affected tube removed (salpingectomy), to give the best chance of a future pregnancy in the womb and lower the risk of another ectopic. If you have only 1 tube or the other tube is not healthy, the surgeon may remove the pregnancy and keep the tube (salpingotomy). A trial of 446 women with a healthy other tube (the ESEP study) found similar rates of ongoing pregnancy by natural conception within 3 years: 56% after removing the tube and 61% after keeping it, a difference that was not statistically significant.
Anti-D injection. If your blood type is RhD negative, the NHS says you may be offered an anti-D injection, depending on your treatment and how many weeks pregnant you were. It helps prevent rhesus disease in future pregnancies.
After an ectopic pregnancy: recovery and feelings
Losing a pregnancy can be devastating. The NHS says many women feel the same sense of grief as if they had lost a family member or partner, and these feelings can last several months, although they usually improve with time. The RCOG notes that it may also mean coming to terms with the possible impact on future fertility, or with the realisation that your own life was at risk. Partners can be affected too.
- give yourself and your partner time to grieve;
- go to all follow-up appointments and blood tests until your hCG level is back to normal;
- if you are struggling, talk to your doctor about counselling. In Malaysia, you can also call Talian HEAL 15555, the Ministry of Health's mental health support line.
Mengandung semula: future pregnancies
The chances of a healthy pregnancy afterwards are good. According to the NHS, most women who have had an ectopic pregnancy will be able to get pregnant again, even if a fallopian tube was removed. Occasionally, fertility treatment such as IVF may be needed.
- When to try again: the NHS says you will probably be advised to wait until you have had at least 2 periods after treatment, and at least 3 months after methotrexate.
- Risk of another ectopic: the RCOG puts it at around 7 to 10 in 100, compared with about 1 in 90 in the general UK population. The RCOG says the chance of a normal pregnancy next time is much greater than that of another ectopic pregnancy.
- Early scan: tell your doctor as soon as you know you are pregnant. The RCOG says you may be offered a scan at 6 to 8 weeks to confirm the pregnancy is in the womb.
If you are planning another pregnancy, our guide to ovulasi explains how to work out your fertile days. If you do not want to become pregnant yet, the RCOG suggests asking your doctor which contraception suits you after an ectopic pregnancy.
Can an ectopic pregnancy be prevented?
You cannot always prevent an ectopic pregnancy. The NHS says you can reduce your risk by:
- using a condom when you are not trying for a baby, to protect yourself against STIs that can cause PID;
- stopping smoking, if you smoke.
If you have had an ectopic pregnancy before, the NHS advises letting your doctor know as soon as possible when you become pregnant again, so early scans can be done.
Frequently asked questions (FAQ)
Apa maksud mengandung luar rahim (what is an ectopic pregnancy)?
Mengandung luar rahim, or ectopic pregnancy, is when a fertilised egg implants and grows outside the womb, usually in one of the fallopian tubes. According to the NHS, around 1 in 90 pregnancies in the UK is ectopic. The pregnancy cannot continue, and it can be dangerous if the tube splits open, so it needs medical care quickly.
Apa tanda-tanda mengandung luar rahim (what are the signs)?
According to the NHS, symptoms tend to develop between the 4th and 12th week of pregnancy and can include a missed period, tummy pain low down on one side, vaginal bleeding or a brown watery discharge, pain in the tip of the shoulder, and discomfort when peeing or pooing. Some women have no symptoms at first. Get medical advice if you have a combination of these symptoms and might be pregnant.
Can the baby be saved in an ectopic pregnancy?
No. The NHS explains that it is not possible to save an ectopic pregnancy, because a fertilised egg outside the womb cannot develop into a baby. It usually has to be removed with medicine or an operation. The RCOG notes that the pregnancy could not have continued without a serious risk to the mother's health.
Will a pregnancy test be positive?
Usually, yes. The RCOG says that if a pregnancy test is negative, it is very unlikely that the symptoms are due to an ectopic pregnancy. However, urine tests are not 100% sensitive: Malaysian doctors have reported a rare case of a ruptured ectopic pregnancy in a woman whose urine pregnancy test was negative. The NHS advises getting medical advice if you have symptoms and might be pregnant, even if you have not had a positive test.
Apa punca mengandung luar rahim (what causes it)?
In many cases the cause is not clear. The NHS says it sometimes happens when the fallopian tubes are narrow or blocked. The risk is higher after pelvic inflammatory disease, a previous ectopic pregnancy, surgery on the fallopian tubes, fertility treatment such as IVF, becoming pregnant while using an IUD or IUS, smoking, and in women over 35. Cleveland Clinic notes that up to 50% of women who have an ectopic pregnancy have none of the known risk factors.
Can I get pregnant again after an ectopic pregnancy?
Most women can. The NHS says most women who have had an ectopic pregnancy will be able to get pregnant again, even if a fallopian tube was removed. The RCOG puts the chance of another ectopic pregnancy at around 7 to 10 in 100, so tell your doctor early when you are pregnant again; you may be offered a scan at 6 to 8 weeks.
How long should I wait before trying again?
The NHS says you will probably be advised to wait until you have had at least 2 periods after treatment. If you were treated with methotrexate, wait at least 3 months, because the medicine could harm a baby if you become pregnant during this time. Try again only when you and your partner feel physically and emotionally ready.
Disclaimer
This article is for general information only and is not a substitute for advice, diagnosis or treatment from a doctor. If you think you may have an ectopic pregnancy, seek medical help immediately. Health supplements are not intended to diagnose, treat, cure or prevent any disease.
References
- Ectopic pregnancy — NHS
- Ectopic pregnancy: symptoms — NHS
- Ectopic pregnancy: diagnosis — NHS
- Ectopic pregnancy: treatment — NHS
- Ectopic pregnancy (patient information) — Royal College of Obstetricians and Gynaecologists
- Ectopic pregnancy — Cleveland Clinic
- Omar AA, et al. A 10-year review of methotrexate treatment for ectopic pregnancy in a Malaysian tertiary referral hospital. Cureus. 2022;14(10):e30395
- Mol F, et al. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet. 2014;383(9927):1483-1489
- Mohamad F, et al. A life-threatening condition: ruptured ectopic pregnancy with negative urine pregnancy test: a case report. Malays Fam Physician. 2021;16(1):121-123
- Talian HEAL terima 163,709 panggilan dalam tempoh tiga tahun — Berita RTM (January 2026)
