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Ectopic Pregnancy

An ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity, most often in the fallopian tube. It is a surgical and medical emergency that complicates 1 to 2% of pregnancies1 and remains the leading cause of first-trimester maternal death.

Hormonal & Women's Health Evidence-Based

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Definition

What Is Ectopic Pregnancy?

An ectopic ("out of place") pregnancy is one in which the embryo implants and begins to develop somewhere other than the lining of the uterus. Roughly 95% occur in the fallopian tube9, which cannot stretch to sustain a growing pregnancy.

An untreated ectopic carries a high risk of tubal rupture, intra-abdominal hemorrhage and shock. Modern care, with early beta-hCG trend, transvaginal ultrasound and treatment by methotrexate, salpingostomy or salpingectomy3, has greatly reduced mortality, but ectopic pregnancy remains the leading cause of first-trimester maternal death in high-income countries. Roughly 1 in 50 pregnancies are ectopic, and the rate is higher in women with a history of pelvic inflammatory disease (PID), tubal surgery, endometriosis, IUD-in-place conception or IVF.

Active ectopic pregnancy is always a medical and surgical emergency. Nothing on this page treats an ectopic pregnancy; the nutrition content is for recovery after treatment, including replacing iron lost in bleeding, and for general health before any future pregnancy.

The uterus with both fallopian tubes and ovaries, and a small pregnancy lodged inside one fallopian tube instead of the uterus

Tubal Ectopic (most common, ~95%)

Implantation in the fallopian tube, most often in the ampulla (70% in a register of 1,800 cases), then isthmus (12%), fimbria (11%) and interstitial portion (2.4%)9.

  • โ†’Strongest risk factors: Prior PID, prior ectopic, tubal surgery, IVF, smoking
  • โ†’Treatment: Methotrexate (early, stable, hCG under about 5,000) or laparoscopic salpingostomy / salpingectomy

Interstitial / Cornual Ectopic (~2 to 4%)

Implantation in the segment of the tube that runs through the uterine muscular wall. Often presents later (7 to 12 weeks) because the surrounding muscle accommodates growth.

  • โ†’Treatment: Methotrexate (multiple-dose) or cornual resection / wedge resection
  • โ†’Future pregnancy: Higher uterine-rupture risk; close monitoring required

Ovarian & Abdominal Ectopic

About 4 to 5% of ectopic pregnancies9. Implantation on the surface of the ovary or directly within the peritoneal cavity (often on bowel, omentum or peritoneum). Strongly linked to IUD-in-place conception (ovarian) and to a prior tubal ectopic or IVF (abdominal). Diagnosis is often delayed because the standard ultrasound search focuses on the tube.

  • โ†’Hallmarks: Empty uterus, no tubal mass, free fluid; sometimes diagnosed at surgery
  • โ†’Treatment: Surgical removal; methotrexate sometimes in carefully selected cases

Cervical & Cesarean Scar Ectopic (under 1% each, rising)

Cervical ectopic implants in the cervical canal below the internal os. Cesarean scar ectopic implants in the fibrous scar of a prior C-section. Both can mimic miscarriage in progress and carry high hemorrhage risk if dilation and curettage is attempted blindly.

  • โ†’Hallmarks: Painless bleeding, gestational sac low in the uterus / in scar niche
  • โ†’Risk factors: Prior cesarean (scar ectopic), IVF, uterine instrumentation
  • โ†’Treatment: Multi-dose methotrexate, uterine artery embolization (blocking the artery that feeds the area), hysteroscopic or laparoscopic resection
By the Numbers

Ectopic Pregnancy by the Numbers

1 to 2%
of reported pregnancies are ectopic, a pregnancy that implants outside the uterus1
About 95%
of 1,800 ectopic pregnancies in a 10-⁠year register were in a fallopian tube, and 70% of all 1,800 were in its ampulla9
About 3%
of US pregnancy-related deaths in 2011 to 2013 were from ectopic pregnancy, almost all after rupture8
About 10%
the chance of another ectopic pregnancy after one, which is why an early scan is offered next time11
About 1 in 3
women with an ectopic pregnancy have no known risk factor, so it has to be ruled out even without one10
56 to 61%
of women in a trial of 446 had an ongoing natural pregnancy within 36 months of surgery, whether the tube was removed or kept12
Signs & Symptoms

Symptoms of Ectopic Pregnancy

The classic triad is a positive pregnancy test, abdominal pain and abnormal bleeding, but atypical presentation is common10. Any pregnancy-positive woman with unilateral pelvic pain, shoulder-tip pain2 or syncope should go to the emergency department now.

SymptomWhat happens
Early & Pregnancy-Related Symptoms
Positive Pregnancy Test with "Off" hCG PatternA positive urine or blood test confirms pregnancy but does not localize it. In ectopic pregnancy, beta-hCG rises slowly (less than 53% in 48 hours) or plateaus, in contrast to the expected near-doubling of a healthy intrauterine pregnancy.
Abnormal Vaginal Bleeding or SpottingLight to moderate brown or dark red bleeding, often intermittent, frequently misread as a "weird period" or threatened miscarriage.
Warning & Rupture Symptoms
Unilateral Pelvic or Lower Abdominal PainSharp, stabbing or cramping pain localized to one side of the lower abdomen, often the side of the implicated tube. Pain may be intermittent at first, then become constant and severe as the tube stretches. This is the most common warning symptom before rupture.
Shoulder-Tip Pain (Referred from Diaphragm)Pain felt at the tip of the shoulder, classically the right, is referred pain from blood irritating the diaphragm after tubal rupture. Shoulder-tip pain in a pregnant person is an emergency until proven otherwise.
Rectal Pressure or Pain on DefecationBlood pooling in the cul-de-sac (the space behind the uterus) can cause a constant urge to have a bowel movement and pain or pressure on defecation. This often accompanies hemoperitoneum from a ruptured ectopic.
Dizziness, Lightheadedness or FaintingCaused by acute blood loss into the abdomen after rupture. Often follows a sudden worsening of pain. Any fainting episode in a pregnancy-positive woman is a surgical emergency. Call 911 or go to the ER immediately; do not drive yourself.
Cold, Pale, Clammy Skin (Shock)Pallor, sweating, rapid pulse and a feeling of impending doom indicate hemorrhagic shock from a ruptured ectopic. Blood pressure may still appear normal in young, healthy women until late, by which point resuscitation is urgent.
Rapid Heart Rate & Falling Blood PressureA persistent heart rate over 100 bpm with low or falling blood pressure in a pregnant person is a late but unmistakable sign of hemorrhage. Combined with abdominal pain, it is an immediate operating-room indication.
๐Ÿšจ Emergency rule: Any positive pregnancy test + one-sided pelvic pain, shoulder-tip pain, fainting or shock symptoms is an ectopic pregnancy until proven otherwise. Call 911 or go to the emergency department; do not wait for an outpatient appointment. Holistic protocols on this page are for prevention and recovery, never for an active ectopic.
Causes

Causes of Ectopic Pregnancy

In many cases it is not clear why an ectopic pregnancy happens; sometimes the fallopian tubes are narrow or blocked, and the factors below raise the risk11.

CauseHow It Contributes to Ectopic PregnancyWhat Helps
Pelvic inflammatory disease and sexually transmitted infectionsPelvic inflammatory disease, usually caused by a sexually transmitted infection, is linked to a higher risk11, and ACOG lists certain infections and pelvic inflammatory disease among the risk factors13Using a condom when not trying for a baby, and testing and treatment for infection, for partners too, as the diagnosis section describes
A previous ectopic pregnancy or tubal surgeryThe chance of another ectopic is around 10% after one, and previous surgery on the tubes, such as a sterilization that did not work, also raises the risk11An early scan in any later pregnancy: tell your doctor as soon as you know you are pregnant11
SmokingSmoking is linked to roughly two to four times the risk (in a dose-dependent way), and the risk falls after quitting5Stopping smoking, one of the two ways the NHS names to lower the risk11
Fertility treatment, or conceiving with an IUD in placeFertility treatment such as IVF raises the risk, and although pregnancy with an IUD or hormonal coil in place is rare, one that does happen is more likely to be ectopic11Prompt assessment of any positive test in these situations rather than assuming all is well, as the signs section advises
Endometriosis and ageACOG lists endometriosis among the risk factors, and age over 35 among other factors that may increase risk13Specialist care for endometriosis; age cannot be changed, so knowing the warning signs matters most
No known risk factorAbout a third of women with an ectopic pregnancy have no known risk factor10Knowing the warning signs in the signs section, and getting checked promptly whenever they appear
Diagnosis

How Ectopic Pregnancy Is Diagnosed

Diagnosis combines a positive pregnancy test, serial beta-hCG trend, transvaginal ultrasound and clinical exam.

TestWhat it shows
At-Home & Pre-Clinical Screening
These observations do not diagnose ectopic pregnancy, but they help you and your clinician act quickly when something is off:
Home Pregnancy Test & Symptom DiaryConfirm pregnancy with a urine test at home. From the first positive test, log any spotting, cramping, one-sided pain, or shoulder-tip pain with date and severity. Bring this log to every visit. In an ectopic, the timeline of symptoms is often as diagnostic as any single lab.
Ectopic Red Flag ChecklistIn any pregnancy under 12 weeks, pregnancy symptoms suddenly fading warrant same-day evaluation. One-sided pelvic pain, brown or red spotting, persistent rectal pressure or sudden worsening of cramping means going to an emergency room now, and sudden severe pain, shoulder pain, weakness or fainting is an emergency on its own: call 911 rather than driving yourself13.
Lab & Clinical Tests
Serial Beta-hCG (Quantitative)Two values drawn 48 hours apart. Healthy intrauterine pregnancies typically show a greater than 53% rise. A rise below 53%, a plateau, or a fall raises suspicion for ectopic or non-viable pregnancy. Above the discriminatory zone (about 1,500 to 2,000 mIU/mL), an empty uterus on transvaginal ultrasound is highly suggestive of ectopic.
Transvaginal Pelvic UltrasoundThe key imaging test. Looks for an intrauterine gestational sac, an adnexal (tubal) mass, the classic "bagel sign" or "ring of fire," and any free fluid in the cul-de-sac. Free fluid plus an adnexal mass is highly suggestive of an ectopic, with or without rupture.
Serum ProgesteroneA progesterone level below 5 ng/mL is rarely compatible with a viable intrauterine pregnancy. A level above 20 ng/mL makes ectopic pregnancy unlikely. Levels in between are non-diagnostic but help risk-stratify when ultrasound is inconclusive.
CBC, Type & Screen, Rh StatusComplete blood count to detect anemia from internal bleeding. Blood type and antibody screen are mandatory in case of transfusion. Rh-negative women require Rh-immunoglobulin (anti-D) after ectopic management to prevent sensitization in future pregnancies.
STI & PID History PanelIn the recovery phase, screen for and treat any ongoing chlamydia, gonorrhea and Mycoplasma genitalium, the leading infectious causes of tubal damage and recurrent ectopic. Address partner treatment to prevent reinfection.
Treatment Comparison

Conventional and Holistic Treatment for Ectopic Pregnancy

An active ectopic pregnancy is always a surgical or medical emergency, and treatment comes first. The holistic side below addresses prevention (before conception) and recovery (after the acute event), never the active emergency itself.

๐ŸŒฟ HOLISTIC
๐Ÿ’Š CONVENTIONAL
๐ŸŒฟ

Holistic / Functional Approach

Reduce tubal-damage risk before conception; support recovery after treatment

Primary Focus
STI prevention, gentle anti-inflammatory nutrition, pelvic-floor support and safe timing around methotrexate4
Duration
At least 2 periods before trying again, and at least 3 months after methotrexate11
Goal
Recover from blood loss and treatment, and prepare for any future pregnancy
Fertility Outcome
56 to 61% had an ongoing natural pregnancy within 36 months in a trial of 446 women12

Full Holistic Approach Includes

  • Stopping folate-containing supplements during methotrexate treatment and restarting them once your OB-GYN confirms it is complete4
  • Whole-food eating, with omega-⁠3 fish, colorful vegetables and iron-rich foods
  • STI screening and treatment for self and partner, to prevent further tubal damage
  • Walking and gentle yoga once your clinician agrees
  • Cycle-phase tracking once periods return, to confirm ovulation and luteal phase before attempting conception
  • Preconception nutrient repletion: folic acid (once methotrexate treatment is complete), vitamin D, iron, B12, omega-⁠3, B-complex
  • Stress and grief support: pregnancy loss after an ectopic deserves real care; therapy or support groups (Resolve, Postpartum Support International, dedicated ectopic groups) are first-line
โš ๏ธ Important boundaries: No supplement, food or "natural" remedy treats an active ectopic; attempts to "manage at home" can be lethal. During methotrexate treatment, stop folate-containing supplements and prenatal vitamins, and restart them when your OB-GYN confirms treatment is complete4. Castor oil packs and deep abdominal massage are contraindicated during pregnancy and immediately after surgery.
Supplement Protocol

Evidence-Based Supplements for Ectopic Pregnancy

These supplements support recovery and preconception preparation; they are never a treatment for an active ectopic pregnancy. Timing matters, especially after methotrexate. Always coordinate with your OB-GYN before starting.

Supplement What it is for Typical range Timing Notes & cautions
Iron (Bisglycinate)Repletes iron lost in tubal bleeding or surgery; restores hemoglobin and ferritin. Iron-deficiency anemia after ectopic pregnancy is very common and undermines energy, sleep and tissue healing.20 to 65 mg elemental iron per day, dosed against ferritinEmpty stomach with vitamin C if tolerated; otherwise with light foodConfirm low ferritin (less than 50 ng/mL) before high-dose iron. Bisglycinate usually causes fewer stomach side effects than ferrous sulfate. The top of this range sits above the 45 mg/day tolerable upper intake level for adults. That is appropriate only when correcting a confirmed deficiency under clinical supervision, not as general supplementation. Test ferritin first, and retest rather than staying on it indefinitely. If you become pregnant, agree on the dose with your midwife or doctor.
Vitamin CImproves absorption of iron from plant foods and supports collagen synthesis for surgical and tubal wound healing.500 to 1,000 mg per day, dividedWith iron and mealsWhole-food vitamin C (camu camu, acerola) is gentler on the stomach.
Vitamin D3 (with K2)Supports immune regulation, anti-inflammatory signaling and uterine receptivity for a future pregnancy. Often low in recovering bodies.D3: set the dose with your clinician; most adults need no blood test first; K2 (MK-⁠7): 100 to 200 mcg per dayWith a fat-containing meal, morning preferredIf you take warfarin, clear any vitamin K supplement with the clinician managing your anticoagulation before starting or stopping it: vitamin K antagonizes warfarin, and changing your intake destabilizes the INR. Consistency matters more than avoidance. This does not apply in the same way to direct oral anticoagulants such as apixaban or rivaroxaban, but tell your prescriber about any supplement you take.
Omega-⁠3 EPA/DHASupports fetal brain development in a future pregnancy; for general health, eating low-mercury fatty fish is the better-supported route.2 to 3 g combined EPA+DHA per dayWith mealsPause about 1 week before any planned surgery if you are still in the surgical recovery window. In heart trials, fish oil supplements raised the risk of atrial fibrillation, an irregular heartbeat, more so above 1 g a day15, so check this dose with your clinician first. If you become pregnant, your midwife or doctor should review it too. At higher doses fish oil can increase bleeding risk; tell your clinician if you take a blood thinner or have heavy bleeding.
Folic AcidLowers the risk of neural tube defects in a future pregnancy. Stop during methotrexate treatment and restart when your OB-GYN confirms treatment is complete4.400 to 800 mcg per day, not during methotrexate treatmentMorning with foodConfirm timing with your OB-GYN. ACOG also lists folate-rich and fortified foods to avoid during treatment; ask your clinician13.
B-ComplexSupports red-blood-cell production, methylation and energy. Especially helpful in recovery from blood loss and surgical stress.1 capsule per day per product labelMorning with foodSkip during the methotrexate folate-avoidance window; restart once cleared.
Vitamin B12Required for red-blood-cell formation. Low levels are more likely with a vegan diet, some medicines or poor absorption; test before supplementing.1,000 mcg per day sublingualMorningSublingual or injectable forms bypass gut absorption issues.
Magnesium GlycinateSupports muscle relaxation (post-surgical cramping) and sleep.300 to 400 mg elemental magnesium per dayEvening, 30 to 60 min before bedMagnesium oxide is poorly absorbed. The top of this range is above the 350 mg/day upper intake level for supplemental magnesium; above that, diarrhea is common. With kidney disease, take it only on your clinician's advice.
ZincRequired for wound healing, immune recovery and ovulation. Often low after acute illness or surgery.15 to 30 mg per dayWith mealsAdd 1 to 2 mg copper if using more than 8 weeks at higher doses.
What to Expect

What to Expect Over Time

Treatment ends the ectopic pregnancy, since it cannot be saved or moved; food supports recovery afterward and never replaces that treatment11.

Treatment and supportive care, together
First Weeks

Treatment is careful monitoring, a methotrexate injection or laparoscopic surgery, with blood hCG tests until the result is negative10. During methotrexate treatment, avoid alcohol, folic acid vitamins and folate-rich foods, and anti-inflammatory painkillers until your clinician says treatment is complete13.

Months 1 to 3

Tiredness and discomfort can last several weeks, and periods can take a few cycles to settle13. Recovery from laparoscopic surgery can take 4 to 6 weeks, and grief after the loss is common and can last months11. Iron is replaced if a blood test shows it is low.

Months 3 to 12

Wait for at least 2 periods before trying again, and at least 3 months after methotrexate, which could harm a baby conceived sooner11. Folic acid restarts once your clinician confirms treatment is complete. In a trial, 56 to 61% had an ongoing natural pregnancy within 36 months, with or without the affected tube12.

Long Term

The chance of another ectopic is around 10%, so tell your doctor as soon as you are pregnant again, for an early scan611.

When to Seek Care

Call 911 or go to the emergency room now for sudden, severe pain in the abdomen or pelvis, shoulder-tip pain, weakness, dizziness or fainting13, or heavy bleeding that soaks a pad soon after you put it on14; a ruptured ectopic is life-threatening, including after methotrexate treatment. Do not wait or try diet first. Go to the emergency room now for one-sided lower abdominal pain, bleeding or brown discharge if you might be pregnant11.

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Next Steps

Emergency Care First, Then Recovery

An active ectopic pregnancy is always an emergency, and no food or supplement treats it. After treatment, food helps replace iron lost in bleeding and supports recovery. Agree on the timing of any supplement with your OB-GYN.

Explore Pelvic Inflammatory Disease (PID) โ†’ Explore Endometriosis โ†’

References & Evidence Notes

Each numbered entry below is either a source you can follow or a note setting out what the evidence does and does not support. Both are numbered together so the markers in the text line up.

Last reviewed October 20, 2026. Supplement entries are cross-checked against the NIH National Center for Complementary and Integrative Health and the Linus Pauling Institute Micronutrient Information Center.7 Read this before anything else. An ectopic pregnancy cannot continue and cannot be moved to the uterus. It is treated with methotrexate or with surgery, and it is the leading cause of first-trimester maternal death. Nothing on this page treats an ectopic pregnancy, and nothing on it should delay you by an hour. If you could be pregnant and you have one-sided pelvic or abdominal pain, vaginal bleeding or spotting, shoulder-tip pain, dizziness, fainting or pain during bowel movements, go to an emergency department now and say you might be pregnant. Shoulder-tip pain and fainting suggest internal bleeding and mean calling emergency services rather than traveling yourself. The nutrition content here is honestly scoped to two windows where it has some leverage: before conception, and during recovery afterward.

  1. On what it is and why it cannot be salvaged: an ectopic pregnancy implants outside the uterine cavity, most often in a fallopian tube, which cannot expand to accommodate a growing pregnancy. Rupture causes intra-abdominal hemorrhage. There is no technique for relocating an ectopic pregnancy to the uterus. Around 1 to 2% of pregnancies are reported to be ectopic. ↩
  2. On symptoms, and why the threshold should be low: classic features are one-sided pelvic pain, amenorrhea and vaginal bleeding, but presentation is variable and some women have no pain until rupture. Shoulder-tip pain arises from blood irritating the diaphragm and indicates intra-abdominal bleeding. Syncope, tachycardia and pallor suggest significant blood loss. Any positive pregnancy test with pain or bleeding deserves prompt assessment, and a negative test does not need to be repeated at home before going in. ↩
  3. On diagnosis and treatment: serial beta-hCG measurement together with transvaginal ultrasound establishes the diagnosis. Management is expectant in carefully selected cases with low and falling hCG, medical with methotrexate, or surgical by salpingostomy or salpingectomy. Anti-D prophylaxis is given where the woman is rhesus negative. The choice depends on hCG level, ultrasound findings, hemodynamic stability and future fertility plans. ↩
  4. On methotrexate and folate, which matters practically: methotrexate is a folate antagonist, and folic acid or folate supplements reduce its effectiveness. Anyone treated medically is asked to stop folate-containing supplements and prenatal vitamins during treatment, avoid alcohol and NSAIDs, and avoid conceiving for a period afterward, usually around three months. This is one of the few genuinely important nutrition facts on this page, and it runs opposite to the usual advice to take folate in pregnancy. ↩
  5. On smoking, the one modifiable factor with a real effect size: smoking is associated with roughly two to four times the risk of ectopic pregnancy in a dose-dependent way, plausibly through impaired tubal ciliary function and altered tubal motility, and risk falls after quitting. Preventing chlamydia, and treating it promptly, is the other genuinely preventive measure, since tubal damage from infection is a leading cause. ↩
  6. On what comes after: most women who have had an ectopic pregnancy can get pregnant again, even if a fallopian tube was removed, NHS, though the risk of a further ectopic is raised, which is why early ultrasound is offered in subsequent pregnancies. Nutritional recovery from blood loss, particularly iron repletion, and the emotional impact of pregnancy loss both deserve attention. Grief after an ectopic pregnancy is frequently underestimated by everyone except the person experiencing it. ↩
  7. National Center for Complementary and Integrative Health (NIH), nccih.nih.gov, and the Linus Pauling Institute Micronutrient Information Center, lpi.oregonstate.edu/mic. ↩
  8. On ectopic pregnancy and maternal deaths: in US national surveillance for 2011 to 2013, ectopic pregnancy accounted for 54 of 2,009 pregnancy-related deaths, 2.7%, almost all from rupture, PubMed 28697109. ↩
  9. On where ectopic pregnancies implant: in a French population register of 1,800 surgically treated ectopic pregnancies over 10 years, 70.0% were ampullary, 12.0% isthmic, 11.1% fimbrial and 2.4% interstitial, about 95% in the tube in all, with 3.2% ovarian and 1.3% abdominal and no cervical cases, PubMed 12456628. ↩
  10. On assessment and treatment: the NICE guideline on ectopic pregnancy advises referring anyone who is unstable, or with significant pain or bleeding, directly to emergency care; notes that atypical presentation is common and that about a third of women with an ectopic pregnancy have no known risk factor; sets out expectant management, methotrexate or surgery by the size of the pregnancy, the hCG level and symptoms, with hCG measured until negative; and advises that people who have had an ectopic pregnancy can refer themselves to an early pregnancy service in future pregnancies, NICE NG126. ↩
  11. On risk, treatment and afterward: NHS guidance states that an ectopic pregnancy cannot be saved and is removed with medicine or an operation; lists pelvic inflammatory disease, a previous ectopic pregnancy (a risk of another of around 10%), previous tubal surgery, fertility treatment, pregnancy with an IUD or IUS in place, smoking and age over 35 among the risk factors; advises using a condom when not trying for a baby and stopping smoking to lower the risk; advises avoiding alcohol after methotrexate until told it is safe, and waiting at least 2 periods before trying again, or at least 3 months after methotrexate because it could harm a baby; notes that most women can get pregnant again, even with a tube removed, that grief can last several months, and that anyone pregnant again should tell their doctor early for an early scan, NHS, ectopic pregnancy. ↩
  12. On fertility after surgery: in a randomized trial of 446 women with a tubal pregnancy and a healthy other tube, 60.7% had an ongoing pregnancy by natural conception within 36 months after the tube was kept and 56.2% after it was removed, a difference that was not significant; keeping the tube meant more persistent pregnancy tissue needing further treatment, PubMed 24499812. ↩
  13. On emergencies and on what to avoid during medical treatment: ACOG's patient guidance states that more than 90% of ectopic pregnancies are in a fallopian tube; that sudden severe pain, shoulder pain or weakness means going to an emergency room; that the risk of rupture lasts until treatment is over; and that during methotrexate treatment people should avoid heavy exercise, sex, alcohol, vitamins and foods containing folic acid (including fortified cereal, enriched bread and pasta, peanuts, dark green leafy vegetables, orange juice and beans), prescription pain medicine and NSAIDs, gas-producing foods and prolonged sun exposure. It notes that about half of women with an ectopic pregnancy have no known risk factor, more than the third that NICE gives (note 10), ACOG, ectopic pregnancy. ↩
  14. On bleeding that is an emergency: NHS guidance advises calling emergency services for anyone pregnant and bleeding who has severe belly pain, shoulder pain, feels sick, faint or dizzy or loses consciousness, or whose bleeding is heavy, soaking a period pad soon after putting it on, NHS, vaginal bleeding in pregnancy. ↩
  15. Gencer B, Djousse L, Al-Ramady OT, Cook NR, Manson JE, Albert CM. Effect of long-term marine omega-⁠3 fatty acids supplementation on the risk of atrial fibrillation in randomized controlled trials of cardiovascular outcomes: a systematic review and meta-analysis. Circulation. 2021;144(25):1981-⁠1990. PubMed 34612056. Seven trials with 81,210 people followed for about 5 years: omega-⁠3 supplements were linked to a higher risk of atrial fibrillation (hazard ratio 1.25), more so in trials of more than 1 g a day (1.49), and the risk rose with each additional gram. ↩
  16. On tea, coffee and iron: NHS guidance on iron deficiency lists tea, coffee, milk and dairy foods among the foods and drinks that can stop the body absorbing iron from other foods and from iron tablets, and advises eating and drinking less of them when iron is low, NHS, iron deficiency anemia. ↩