An ectopic pregnancy occurs when a fertilized egg implants itself outside of the uterus. They’re also called “tubal pregnancies” because most of them happen in the fallopian tubes. Whether there’s a problem with the egg or the tube, the egg gets stuck on its journey to the uterus.
A pregnancy can’t survive outside of the uterus, so all ectopic pregnancies must end. It used to be that about 90% of women with ectopic pregnancies had to have surgery. Today, the number of surgeries is much lower, and many more ectopic pregnancies are managed with medication that prevents them from progressing.
If you’re diagnosed with an ectopic pregnancy, how your doctor will treat it depends on how far the pregnancy has progressed, where the embryo is, and how severe your symptoms are.
An early ectopic pregnancy may be managed with medicine. If you have low levels of hCG -- a hormone your body makes when you’re pregnant -- then you aren’t very far along. If there’s no damage to the fallopian tube, your doctor can give you an injection of a drug called methotrexate (Trexall).
Methotrexate stops the cells from growing and allows your body to absorb the pregnancy. It also saves your fallopian tubes and gives you a better chance of having successful pregnancies in the future.
Women used to stay in the hospital for a series of methotrexate injections. Now it’s an outpatient procedure, but your doctor will monitor your hCG levels closely during the few weeks after to make sure they get back to zero.
One injection could do the trick, but if the numbers don’t drop like they should, you might have more injections.
If methotrexate therapy doesn’t work, surgery is the next step. It’s also the only option for women with high hCG levels, severe symptoms, and ruptured or damaged fallopian tubes.
You may have laparoscopic surgery that involves a very small cut, a tiny camera, and no damage to your fallopian tube. Surgeons prefer to use this method rather than doing surgery with a larger cut. But sometimes that’s not possible. If your tube has ruptured or been severely damaged and you’ve had severe bleeding, you’ll probably need emergency surgery with the bigger incision. In these situations, the surgeons might have to remove your fallopian tube.
After surgery, your doctors will watch your hCG levels to make sure they’re going down and the pregnancy was removed properly. Some women also need a methotrexate injection so everything returns to normal.