Ectopic Pregnancy - Treatment Overview
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.
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 not 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
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
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.
you have surgery, you may take methotrexate afterward.
If your blood type is
Rh immunoglobulin may be 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 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
- 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 may be your only treatment option if you have internal bleeding.