Ectopic pregnancy - Treating ectopic pregnancy

The baby cannot be saved in an ectopic pregnancy.

If the ectopic pregnancy is diagnosed before your fallopian tube ruptures, you have the following treatment options:

active monitoring – where you receive no immediate treatment but your condition is carefully monitored
medication – a medicine called methotrexate can be used to stop the ectopic pregnancy growing
surgery – surgery can be used to remove the egg

Your specialist or gynaecologist can advise you on the benefits and risks of each option.

Active monitoring

If you are only experiencing mild symptoms, there is a chance that the pregnancy will resolve itself. The fertilised egg will die and then be absorbed into nearby tissue, without the need for treatment.

This is more likely if your blood tests show low levels of the human chorionic gonadotropin (hCG) hormone.

Should you decide on this option, you will still need to have regular blood tests and, in some cases, ultrasound scans to assess the pregnancy's progress.

If tests do not show a continued drop in hCG levels, you will need more treatment (this usually happens in around one in three cases treated using active monitoring).

The advantage of active monitoring is that you won’t have to experience any side effects of treatment.

A disadvantage is that there is still a small risk of your fallopian tubes splitting open (tubal rupture), even if blood tests show low levels of the hCG hormone.

Methotrexate

If an ectopic pregnancy is growing but is diagnosed early enough, it can be ended using a medicine called methotrexate.

Methotrexate works by stopping the embryo cells growing. It is usually only suitable if the ectopic pregnancy:

is no larger than 3.5cm in diameter, with no visible heartbeat
is not causing a lot of pain
has a serum hCG level less than 1500 IU/litre
has no intrauterine pregnancy (as confirmed by an ultrasound scan)

Methotrexate may also not be suitable if you have one or more of these:

a condition known to weaken the immune system, such as diabetes
any type of blood disorder that causes low levels of certain types of blood cells, such as anaemia
liver disease
kidney disease

If methotrexate is recommended, your condition will need to be closely monitored through regular blood tests after you have taken the medicine.

Methotrexate is usually given as a single injection into your buttocks, and a second dose is sometimes required.

You need to use reliable contraception for three to six months (depending on how many doses) after taking methotrexate. This is because there is an increased risk of developmental problems in your next baby if you become pregnant after being given the medication.

It is also important to avoid drinking alcohol until you are told it is safe to do so, as drinking soon after receiving a dose of methotrexate can damage your liver.

The most common side effect of methotrexate is abdominal pain, which usually develops a day or two after a dose is given. This pain is usually mild and should pass within 24-48 hours.

Other side effects can include:

feeling sick
being sick
diarrhoea
dizziness
mouth ulcers

You will need to have blood tests around days four and seven after taking methotrexate. If the test doesn't show a significant drop in hCG levels, you may need surgery.

There is still around a 1 in 14 chance of your fallopian tubes splitting open (rupture) after medical treatment with methotrexate, even if your hCG levels are going down. This means you need to be aware of the potential symptoms of a rupture – be ready to call an ambulance if you think one has happened.

Surgery

Surgery to remove the egg is the most common treatment for an ectopic pregnancy. Keyhole surgery (laparoscopy) is normally used.

This is where a tiny camera and surgical instruments are inserted through small cuts in your abdomen. This is done under general anaesthetic (meaning you will be asleep). If your other fallopian tube looks healthy, then the tube containing your ectopic pregnancy is usually removed (in a procedure known as a salpingectomy). This is the most effective treatment and does not reduce the chance of becoming pregnant again.

To avoid having two surgical procedures, surgery to remove an ectopic pregnancy or fallopian tube is sometimes done at the same time as a laparoscopy to confirm your ectopic pregnancy.

Your consultant will explain the chances of this happening before you go into hospital, and will ask if it is ok to remove your fallopian tubes, should this be necessary.

Most women can leave hospital a few days after surgery, although it can take up to a month before you fully recover.

If your fallopian tube has ruptured, you will need emergency surgery. The surgeon will make an incision in your abdomen (this is known as a laparotomy) to stop the bleeding and, if possible, repair your fallopian tube.

After surgery for an ectopic pregnancy, you should be offered a treatment called anti-D rhesus prophylaxis if your blood type is RhD negative (see blood groups for more information). This involves an injection of anti-D immunoglobulin, which helps prevent problems caused by rhesus disease in future pregnancies.

Follow up

Once your ectopic pregnancy has been treated, you may want to consider making a follow-up appointment with your GP.

Your GP should be able to discuss a number of issues, such as:

what counselling services are available, if you feel you need this
the likely impact your ectopic pregnancy and its treatment will have on your fertility
when (or if) it is safe to try for another baby
what options are available if your fallopian tubes have been damaged or removed