Can a pregnancy test detect an ectopic pregnancy?

Sep 24, 2025 Source: Cainiu Health

Dr. Zhang Lu

Introduction

Pregnancy test strips detect human chorionic gonadotropin (hCG) in urine. A positive result appears whenever hCG levels are elevated, but such tests cannot identify ectopic pregnancies. Early, unruptured cases may be conservatively treated with methotrexate, while ruptured cases require surgical intervention to control bleeding and remove the ectopic tissue. Women planning pregnancy should be aware of these warning signs and promptly contact an obstetrician if any abnormalities arise—do not let a positive test strip result lead to complacency.

Under normal circumstances, pregnancy test strips detect human chorionic gonadotropin (hCG) in urine. As long as hCG levels are elevated, the test will show a positive result, but it cannot distinguish ectopic pregnancies. The detailed explanation is as follows:

In ectopic pregnancies, the embryo implants outside the uterus, commonly in the fallopian tube. During early stages, the hCG level curve often overlaps with that of a normal intrauterine pregnancy, making it easy to miss the diagnosis based solely on a single urine test. As the gestational sac grows, patients typically experience spotting after missed periods and mild, one-sided lower abdominal pain. Without timely intervention, they may suddenly develop severe, tearing pain accompanied by internal bleeding, progressing to an acute abdomen condition.

A definitive diagnosis requires serial blood tests to monitor hCG levels and transvaginal ultrasound. If hCG levels increase by less than 66% every 48 hours or if no gestational sac is visible in the uterine cavity on ultrasound, ectopic pregnancy should be highly suspected. Individuals with a history of pelvic inflammatory disease, tubal surgery, or previous ectopic pregnancy are at higher risk. Immediate medical evaluation is essential whenever a positive pregnancy test is accompanied by abdominal pain or vaginal bleeding.

Unruptured ectopic pregnancies in early stages may be managed conservatively with methotrexate, while ruptured cases require emergency surgery to control bleeding and remove the ectopic tissue. Women planning pregnancy should be aware of these warning signs and promptly contact an obstetrician upon noticing any abnormalities—do not assume safety simply because the test strip shows positive.

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