Medical Treatment of Ectopic Pregnancy

An ectopic pregnancy is a pregnancy that occurs outside the uterus. Since these abnormal pregnancies can result in life threatening bleeding, all ectopic pregnancies require medical treatment.

Understanding Ectopic Pregnancy

Only 2 percent or fewer pregnancies occur outside the uterus. The overwhelming majority of ectopic pregnancies (approximately 95 percent) occur in the fallopian tubes. Rarely the fertilized eggs implants in the cervix, ovary or abdomen.

Ectopic pregnancy is more likely to occur if the fallopian tubes have been damaged from past pelvic infection, endometriosis, appendicitis, pelvic surgery or exposure to diethylstilbestrol (DES).

Symptoms of ectopic pregnancy include abnormal or irregular bleeding, pelvic pain and low hCG or progesterone levels.

An ectopic pregnancy is often emotionally devastating, especially for couples who are undergoing infertility treatment.  Unfortunately, ectopic pregnancies are not viable pregnancies and the embryo cannot be transplanted to the uterus.

Treatment of Ectopic Pregnancy

Early treatment of ectopic pregnancy is the goal, since surgery can usually be avoided when the abnormal pregnancy is identified within the first or second week.

Fertility specialists utilize the following ectopic pregnancy treatment therapies:

• Observation – some ectopic pregnancies resolve without treatment, so your fertility specialist or OBGYN may take a wait and watch approach, especially if the condition is identified early and there are no symptoms. During this time, intense exercise and sexual intercourse should be avoided and hCG levels should be monitored weekly, or more often, if symptoms develop. The majority of these cases resolve within a month, but if pain or symptoms are present or if hCG levels do not drop as expected, additional treatment may be necessary
• Medical treatment – early, unruptured ectopic pregnancies with no signs of internal bleeding or severe pain may be medically managed through the use of the drug, methotrexate. Methotrexate is given as a single injection, or series of injections, and works by destroying ectopic pregnancy tissue so that it can be reabsorbed. If hCG levels remain high after the initial injection, multiple injections of the drug may be required

There are no known long-term side effects of methotrexate, but short term side effects include mouth and GI tract ulcers, temporary changes in liver function and sun sensitivity. In rare cases, patients have experienced decreased platelet production or pneumonia. Patients taking methotrexate should not drink alcohol or take folic acid

• Surgery – when there is extensive scarring or the ectopic pregnancy has ruptured, surgery may be required. However, the procedure can usually be done laparoscopically. If the procedure is done before rupture occurs, a salpingostomy may be possible. This involves clearing the tissue while allowing the tube to be spared. If this approach is not possible or some of the ectopic tissue still remains afterwards, additional surgery or methotrexate therapy may be needed.

When possible, efforts are made to spare the tube by performing a partial salpingectomy to remove a small middle section of the tube. This allows tube ends to later be rejoined. In the case of severe fallopian tube damage or large ectopic pregnancy, a total salpingectomy may be required. Rarely, the ovary or a portion of the involved ovary may also be removed.

Emergency situations and cases involving extensive scarring may require a laparotomy, a surgical procedure performed through a larger incision in the lower abdomen.

After Ectopic Pregnancy

Feelings of loss, sadness or other emotions are normal after ectopic pregnancy. Some individuals find grief counseling and support groups helpful.

Although having an ectopic pregnancy increases the risk of other ectopic pregnancies, more than half of all women who have an ectopic pregnancy later have a normal pregnancy.