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Ectopic pregnancy - Treating ectopic pregnancy

NHS Choices Medical Reference

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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 growth of the egg
  • surgery - surgery can be used to remove the egg

Your specialist or gynaecologist will be able to advise you about the benefits and risks of each option.

Active monitoring

If you are only experiencing mild symptoms then there is a chance that the pregnancy will resolve by 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.

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

If tests do not show a continued drop in the hCG levels, additional treatment will be required (this is usually the case 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 growth of the embryo cells. It is usually only suitable if the egg is no larger than 3.5cm in diameter.

Methotrexate may also not be suitable if you have one or more of the following conditions:

  • 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 for you, 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. Sometimes, a second dose is required.

You need to use reliable contraception for three to six months (depending on how many doses) after taking methotrexate as there is an increased risk of development 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 receiving a dose. This pain is usually mild and should pass within 24-48 hours.

Other side effects can include:

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

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

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. If your fallopian tube has been damaged, it may also need to be removed (this procedure is called a salpingectomy). 

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 chance of this happening to you before you go into hospital and will ask your consent to remove your fallopian tubes, if this is found to be necessary.

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

If your fallopian tube has ruptured, you will need emergency surgery. The surgeon will make an incision in your abdomen (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 that 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
Medical Review: March 14, 2012
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