In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. The decision about which treatment to use depends on how early the pregnancy is detected and your overall condition. For an early ectopic pregnancy that is not causing bleeding, you may have a choice between using medicine or surgery to end the pregnancy.

Medication. Using methotrexate to end an ectopic pregnancy spares you from an incision and general anesthesia. But it does cause side effects and can take several weeks of hormone blood-level testing to make sure that treatment has been successful. Methotrexate is most likely to work:

• When your pregnancy hormone levels (human chorionic gonadotropin, or hCG) are low (less than 5,000).
• During the first 6 weeks of pregnancy.
• When the embryo has no heart activity.

Surgery. If you have an ectopic pregnancy that is causing severe symptoms, bleeding, or high hCG levels, surgery is needed. This is because medicine is not likely to work and a rupture becomes more likely as time passes. Whenever possible, laparoscopic surgery that uses a small incision is done. For a ruptured ectopic pregnancy, emergency surgery is needed.

Expectant management. For an early ectopic pregnancy that appears to be naturally miscarrying (aborting) on its own, you may not need treatment. Your health professional will regularly test your blood to make sure that your pregnancy hormone (hCG, or human chorionic gonadotropin) levels are dropping. This is called expectant management.

Ectopic pregnancies can be resistant to treatment.

• If hCG levels do not drop or bleeding does not stop after taking methotrexate, your next step may be surgery.
• If you have surgery, you may take methotrexate afterward.

If your blood type is Rh-negative, Rh immunoglobulin is used to protect any future pregnancies against Rh sensitization. For more information, see the topic Rh Sensitization During Pregnancy.

What To Think About

Surgery versus medication

• Methotrexate is usually the first treatment choice for ending an early ectopic pregnancy. Regular follow-up blood tests are needed for days to weeks after the medicine is injected.
• There are different types of surgery for a tubal ectopic pregnancy-when possible, only a slit is made in the fallopian tube (salpingostomy), rather than removing a section of the tube (salpingectomy).
• On average, salpingostomy is equal to methotrexate (for an early ectopic pregnancy) in terms of being effective and preserving a woman's ability to become pregnant in the future.⁹
• Although surgery is a faster treatment, it can cause scar tissue that could cause future pregnancy problems. Tubal surgery may damage the fallopian tube, depending on where and how big the embryo is and the type of surgery needed.

Surgery may be your only treatment option if an ectopic pregnancy has gone past 6 weeks or if you have internal bleeding.