You are currently using an unsupported browser which could affect the appearance and functionality of this website. Please consider upgrading to the latest version or using alternatives such as Mozilla Firefox, Google Chrome or Microsoft Edge.

Diagnosis and Management of Ectopic Pregnancy (Green-top Guideline No. 21)


An ectopic pregnancy is any pregnancy implanted outside of the endometrial cavity. In the UK, the incidence is approximately 11/1000 pregnancies, with an estimated 11 000 ectopic pregnancies diagnosed each year. This guideline will cover the following ectopic pregnancies: tubal, cervical, caesarean scar, interstitial, cornual, ovarian, abdominal and heterotopic. The diagnosis and management of pregnancy of unknown location will not be covered.

Unfortunately, women still die from ectopic pregnancy, with six maternal deaths reported between 2006 and 2008. However, the case fatality rate has decreased over recent years, suggesting that earlier diagnosis and treatment may have made an impact.

Risk factors for ectopic pregnancy include tubal damage following surgery or infection, smoking and in vitro fertilisation. However, the majority of women with an ectopic pregnancy have no identifiable risk factor.

Update June 2022: An update of this guideline is currently in development, which will address the Healthcare Safety Investigation Branch (HSIB) recommendations published in the 2020 report The diagnosis of ectopic pregnancy.

COVID disclaimer

This guideline was developed as part of the regular updates to programme of Green-top Guidelines, as outlined in our document Developing a Green-top Guideline: Guidance for developers, and prior to the emergence of COVID-19.

Version history

This is the first edition of this guideline; the second edition is currently in development.

Developer declaration of interests

Ms CJ Elson FRCOG, London: Ms Elson is a medical advisor and volunteer for the Ectopic Pregnancy Trust.

Mr R Salim MRCOG, London: None declared.

Miss N Potdar MRCOG, Leicester: None declared.

Ms M Chetty MRCOG, Edinburgh: None declared.

Miss JA Ross FRCOG, London: Ms Ross is a medical advisor to the Ectopic Pregnancy Trust and a member of the Association of Early Pregnancy Units. She receives payments for running courses sponsored by Cook UK.

Ms EJ Kirk MRCOG, London: Ms Kirk is coordinator of the European Society of Human Reproduction and Embryology Special Interest Group in Implantation and Early Pregnancy, is on the executive committee of the Association of Early Pregnancy Units and is a medical advisor to the Ectopic Pregnancy Trust.


This page was last reviewed 04 November 2016.