Kehr's sign and ectopic pregnancy: what it can mean

The diaphragm is the muscle beneath the lungs and above the abdominal organs. Blood or irritation in the abdominal cavity can stimulate nerves connected with the shoulder, so the pain may be felt at the tip of one shoulder rather than where the problem began. It may become more noticeable when lying down or breathing deeply.

Shoulder-tip pain has several possible causes and does not by itself diagnose an ectopic pregnancy. An ectopic pregnancy develops outside the main cavity of the womb, often in a fallopian tube. If the tube bleeds or ruptures, blood can irritate the diaphragm. Other possible symptoms include one-sided pelvic pain, vaginal bleeding, dizziness, weakness or fainting. Read more about [Ectopic Pregnancy](/conditions/ectopic-pregnancy/) and [Pelvic Pain](/symptoms/pelvic-pain/).

If you could be pregnant and have new shoulder-tip pain, pelvic pain or vaginal bleeding, seek urgent medical care. Do not wait for a home pregnancy test to become positive if your symptoms are severe. Tell the clinician when your last period began, whether pregnancy is possible, where the pain is located, and whether you have had bleeding, dizziness or fainting.

Assessment may include a pregnancy test, blood tests and a [Transvaginal Ultrasound](/treatments/diagnostics-and-imaging/transvaginal-ultrasound/) to locate the pregnancy and check for bleeding. Treatment depends on the scan, symptoms, pregnancy hormone results and overall condition. Options may include close monitoring, medicine or surgery. A [Salpingectomy](/treatments/gynaecological-surgery/salpingectomy/) is one operation used in some ectopic pregnancies.

Call emergency services or go to an emergency department immediately for severe or worsening abdominal or pelvic pain, shoulder-tip pain with suspected pregnancy, heavy vaginal bleeding, fainting, marked dizziness, unusual weakness, pale or clammy skin, or trouble breathing. These signs can occur with internal bleeding, which cannot be assessed safely at home.

Do not drive yourself if you feel faint or weak. Keep your phone nearby and tell someone where you are. Pelvic inflammatory disease can affect the fallopian tubes and is a separate condition; it should not be used to explain away urgent symptoms.

You could ask: Where is the pregnancy located? Is there evidence of bleeding? Which tests need repeating? What symptoms mean I should return immediately? Which treatment is suitable for my scan and blood-test results? What follow-up will confirm that the pregnancy has resolved?