For many women, the first signs of an ectopic pregnancy may not seem unusual.
A missed period. A positive pregnancy test. Mild abdominal pain. Some spotting.
Early in pregnancy, these symptoms can be easy to dismiss or confuse with the normal changes of pregnancy or an early pregnancy loss.
But an ectopic pregnancy can become a life-threatening emergency if it is not diagnosed and treated before the fallopian tube ruptures.
ProPublica’s analysis of U.S. Centers for Disease Control and Prevention (CDC) mortality data identified 196 deaths involving ectopic pregnancy from 2020 through 2025, compared with 106 during the previous six-year period.
The findings raise an important question that goes beyond the statistics:
When an ectopic pregnancy is missed or treatment is delayed, could an opportunity to prevent serious injury have been missed?
What Is an Ectopic Pregnancy?
An ectopic pregnancy occurs when a fertilized egg implants somewhere outside the uterus.
More than 90% of ectopic pregnancies occur in a fallopian tube. As the pregnancy develops, the tube can stretch and eventually rupture. A rupture can cause severe internal bleeding and become a life-threatening emergency requiring immediate treatment, which may include emergency surgery.
An ectopic pregnancy cannot develop normally or be moved into the uterus. Treatment may involve medication or surgery, depending on factors such as whether the pregnancy has ruptured and the patient’s clinical condition.
The condition is relatively uncommon, but it is medically significant because the consequences of a missed diagnosis can be severe.
And diagnosis is not always straightforward.
Why Can Ectopic Pregnancy Be Difficult to Diagnose?
One of the challenges is that the earliest symptoms can resemble other conditions.
According to the American College of Obstetricians and Gynecologists (ACOG), early symptoms can include abnormal vaginal bleeding, low back pain, abdominal or pelvic pain, and mild cramping on one side of the pelvis. These symptoms can occur before a woman knows that she is pregnant.
A patient may therefore seek care for what appears to be relatively mild pain or bleeding.
At this stage, an ectopic pregnancy may not yet be obvious.
Healthcare professionals may use ultrasound and blood testing for the pregnancy hormone human chorionic gonadotropin (hCG) as part of the evaluation. Sometimes, however, an ultrasound does not immediately establish where the pregnancy is located. Additional testing and follow-up may be necessary.
This is one reason the diagnostic process matters so much.
The absence of a definitive diagnosis during the first examination does not necessarily mean that nothing is wrong. Depending on the patient’s symptoms and clinical circumstances, continued monitoring, repeat testing, specialist assessment, and clear instructions about when to seek emergency care may be necessary.
What Do We Know About Ectopic Pregnancy Trends?
The recent ProPublica analysis is not the first research to identify concerns about ectopic pregnancy in the United States.
A CDC study examining emergency-department data from 2006 through 2013 found that the ratio of emergency-department visits involving an ectopic-pregnancy diagnosis increased from 11.0 to 13.7 per 1,000 live births during that period. The researchers concluded that emergency-department ectopic pregnancy diagnoses appeared to be increasing, although the reasons for the increase were unclear.
The newer ProPublica analysis examined deaths during a later period and found that the number of women dying after an ectopic pregnancy had nearly doubled. Experts quoted by ProPublica emphasized that ectopic-pregnancy deaths should be rare when the condition is recognized and treated in time.
These findings should be interpreted carefully.
The older study examined emergency-department diagnoses, while the newer ProPublica analysis examined deaths involving ectopic pregnancy. They are different measures and cover different periods.
Furthermore, ProPublica notes that hospitals are not required to report all ectopic-pregnancy diagnoses nationally. That means the available data cannot establish whether ectopic pregnancies themselves are becoming more common today.
What the recent data do show is a concerning increase in deaths associated with the condition. The reasons for that increase remain uncertain and require further investigation.
When Does a Delayed Diagnosis Become a Legal Issue?
A delayed diagnosis is not automatically medical malpractice. Ectopic pregnancy can be difficult to identify, especially during the earliest stages. Some patients may have symptoms that overlap with miscarriage, gastrointestinal illness, urinary problems, or other conditions.
However, delayed care may raise legal questions when providers fail to respond appropriately to the information available at the time.
Potential concerns may include:
Failure to recognize warning signs
A provider may have failed to adequately consider ectopic pregnancy when a patient presented with a positive pregnancy test, abdominal pain, bleeding, dizziness, or other concerning symptoms.
Failure to order or interpret appropriate testing
A claim may involve the failure to order or appropriately interpret testing that was indicated by the patient’s presentation, which may include ultrasound, quantitative hCG testing, or repeat testing. It may also involve a failure to recognize or appropriately communicate concerning results.
Premature discharge
A patient may have been sent home despite clinical findings requiring additional evaluation or treatment, such as worsening pain, unstable vital signs, significant bleeding, concerning laboratory results, or an unresolved pregnancy location without an appropriate follow-up plan.
Failure to consult or transfer
Depending on the patient’s condition and the hospital’s capabilities, consultation with an OB-GYN or timely transfer may be necessary when a hospital lacks the resources to appropriately evaluate or treat a suspected ectopic pregnancy.
Inadequate follow-up
When the diagnosis remains uncertain, an appropriate follow-up plan may be an important part of the patient’s care. A failure to arrange repeat testing, provide specific return precautions, or communicate the urgency of follow-up may contribute to a preventable delay.
Failure to recognize deterioration
Clinical findings such as fainting, rapid heart rate, low blood pressure, increasing abdominal or pelvic pain, pallor, weakness, or other signs of hemodynamic instability may raise concern for internal bleeding. A failure to appropriately evaluate and respond to deterioration may have serious consequences.
These issues must be evaluated according to the applicable state law, the patient’s medical records, the provider’s role, the hospital’s capabilities, and expert medical testimony.
The Consequences of Delayed Diagnosis
A ruptured ectopic pregnancy can cause significant physical and emotional harm. A patient may require emergency surgery, removal of a fallopian tube, blood transfusions, or intensive-care treatment. In severe cases, the patient may suffer permanent disability or death.
Other consequences may include:
- Potential effects on future fertility
- Severe pain and emotional trauma
- Lost wages or loss of earning capacity
- Medical expenses
- Loss of consortium
- In fatal cases, potential wrongful-death damages for surviving family members
In a medical-malpractice case, causation is often a central issue. The analysis may include whether earlier recognition and appropriate treatment would, under the applicable legal standard, have prevented or reduced the patient’s injuries.
That determination generally requires a review of the medical records, the timing of symptoms and treatment, test results, communications, hospital policies, and expert opinions.
Who Is at Risk of Ectopic Pregnancy?
Certain factors are associated with an increased risk of ectopic pregnancy, including a prior ectopic pregnancy, previous fallopian-tube surgery, pelvic inflammatory disease, endometriosis, infertility, smoking, and pregnancy resulting from assisted reproductive technology.
But there is an important point for patients to understand:
Ectopic pregnancy can also occur in patients with no known risk factors. The absence of a recognized risk factor does not rule it out.
Knowing the warning signs does not replace medical evaluation, but it can help patients recognize when symptoms require attention.
Early symptoms can include vaginal bleeding or spotting, abdominal or pelvic pain, pain concentrated on one side, lower back pain, and cramping.
The key point is not that every episode of early-pregnancy bleeding or abdominal pain is an ectopic pregnancy. Many different conditions can cause these symptoms.
When Should a Family Consider Further Investigation?
When a patient suffers a serious outcome from an ectopic pregnancy, families may understandably ask whether anything could have been done differently.
That question cannot be answered simply by looking at the final outcome. A medical-legal review may instead examine the sequence of events leading up to the diagnosis. Medical records can be particularly important in determining what happened.
They may show what symptoms were reported, what examinations were performed, what tests were ordered, what clinicians documented, what results were available, what follow-up was recommended, and how the patient’s condition changed over time.
A delayed diagnosis by itself does not establish medical negligence. The circumstances of each case must be evaluated individually, including the applicable standard of care and whether any alleged failure actually caused the patient’s injury.
Why More Research Matters
The recent increase in ectopic-pregnancy deaths also raises a broader patient-safety question.
Why are more women dying from a condition that can often be treated successfully when identified and managed promptly?
ProPublica’s investigation highlighted gaps in national surveillance and research involving ectopic pregnancy. Without comprehensive data on diagnoses and outcomes, researchers cannot yet determine whether the increase in deaths reflects changes in the incidence of ectopic pregnancy, delays in diagnosis or treatment, barriers to care, differences in treatment, or other factors.
The Bottom Line
Ectopic pregnancy is a medical emergency, but it is not always an obvious one at the beginning.
Its early symptoms can overlap with other pregnancy-related conditions. Diagnosis may sometimes require more than a single examination or ultrasound. And when an ectopic pregnancy remains unresolved, the risk of rupture can become increasingly urgent.
For patients, understanding the warning signs and seeking appropriate medical attention is important.
For healthcare providers, careful assessment, appropriate testing, follow-up, communication, and timely escalation can be critical.
And when a patient suffers a serious injury after repeated visits, worsening symptoms, concerning test results, or delays in diagnosis or treatment, the question may extend beyond simply what happened.
In the ectopic-pregnancy malpractice cases I have reviewed, the question is rarely as simple as whether the first healthcare provider should have immediately known that the patient had an ectopic pregnancy. Early diagnosis can genuinely be difficult.
The questions are often what happened next.
Was ectopic pregnancy appropriately considered? Were concerning results recognized and followed up? Was appropriate follow-up arranged? Did someone respond when the patient’s symptoms changed? And was there an opportunity to diagnose and treat the pregnancy before it ruptured?
Those questions can only be answered by carefully reviewing the timeline, the medical records, the applicable standard of care, and the information available to the healthcare providers at each point along the way.
Disclaimer
This article is provided for general informational and educational purposes only and is not intended to provide medical or legal advice. If you believe that you or a loved one may have suffered harm because of a delayed or missed diagnosis, you should consult a qualified attorney who can review the circumstances of your individual case and advise you regarding your legal rights and options.
Sources
- ProPublica — Ectopic Pregnancy Deaths Have Nearly Doubled https://www.propublica.org/article/ectopic-pregnancy-deaths-doubled-analysis
- American College of Obstetricians and Gynecologists (ACOG) — Ectopic Pregnancy https://www.acog.org/womens-health/faqs/ectopic-pregnancy
- ACOG — Facts Are Important: Understanding Ectopic Pregnancy https://www.acog.org/advocacy/facts-are-important/understanding-ectopic-pregnancy
- Trends in Ectopic Pregnancy Diagnoses in United States Emergency Departments, 2006–2013 https://pubmed.ncbi.nlm.nih.gov/31848926/