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.
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 worked. Methotrexate is most likely to work:
- When your pregnancy hormone levels (human chorionic gonadotropin, or hCG) are low (less than 5,000).
- When the embryo has no heart activity.
If you have an ectopic pregnancy that is causing severe symptoms, bleeding, or high hCG levels, surgery is usually needed. This is because medicine is less likely to work and a rupture becomes more likely as time passes. When possible, laparoscopic surgery that uses a small incision is done. For a ruptured ectopic pregnancy, emergency surgery is needed.
For an early ectopic pregnancy that appears to be naturally miscarrying (aborting) on its own, you may not need treatment. Your doctor 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.
What to think about
Surgery versus medicine
- 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. As long as you have one healthy fallopian tube, salpingostomy (small tubal slit) and salpingectomy (part of a tube removed) have about the same effect on your future fertility. But if your other tube is damaged, your doctor may try to do a salpingostomy. This may improve your chances of getting pregnant in the future.
- 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 you have internal bleeding.