Ectopic Pregnancy Treatment

Can an ectopic pregnancy be saved

An ectopic pregnancy cannot continue as a normal one because it is not possible for the extra-uterine tissues to provide the fetus with adequate blood and nutrient supply or support for growth ^{[1, 2]}.

Removing the extrauterine fetus is the only option for saving the mother’s life as well as preserving her fertility. The doctor may choose to monitor the condition for a few days before deciding on a specific treatment measure.

Management by monitoring

When diagnosed at an early stage, an ectopic pregnancy may undergo a natural miscarriage without requiring any medical treatment. In such cases, regular blood tests are performed to check if your hCG hormone levels are dropping at a steady rate ^[3]. Researches show that when the lowering hormone levels are monitored properly, up to half of all ectopic pregnancies do not need any treatment as they end naturally through expectant management ^[4].

Methotrexate for Ectopic Pregnancy

Unless there are any immediate risks of complication, your doctor may opt for treatment with methotrexate, a medication that stops the embryo cells from multiplying ^[5]. Once the methotrexate is injected, regular blood tests can help to make sure that it is working by showing a steady decrease in the pregnancy hormone levels. One of the reasons to prefer methotrexate over surgery is the fact that the former does not carry as much a risk of damaging the fallopian tube as the latter ^[6].

Who can get methotrexate

However, this treatment option can only be used when your ectopic pregnancy matches the following criteria ^{[2, 7]}:

The fetus is about 3.5 cm in diameter or smaller, with no detectable heartbeat
Your hCG levels are lower than 1500 IU/liter
You are not having too much pain
An ultrasound scan has confirmed that you do not have an intrauterine pregnancy
There is no internal bleeding
You do not have any other condition or complication such as kidney or liver problems, peptic ulcers or an infectious disease ^[4].

Common side effects of management with methotrexate

Abdominal pain or cramping (may be similar to gas pain) that usually lasts for a couple of days after the injection. However, this symptom may also indicate a ruptured ectopic pregnancy so make sure to call your doctor in case of considerable pain ^[4].
Feeling lightheaded (also may be a sign of rupture)
Extreme Fatigue
Bleeding or spotting
Indigestion, nausea and vomiting ^[8]
Moderate hair loss
Skin rashes/sunburn

You still have a considerable chance (1 in 14) of suffering from a ruptured fallopian tube after the methotrexate treatment ^[2], even with lowering hormone levels. A surgery is needed in such cases ^[9].

Surgery for treating an ectopic pregnancy

Surgery may be the only treatment option left in ectopic pregnancies detected at a later stage with suspected internal bleeding due to rupture ^[7]. A laparoscopic or keyhole surgery is the common method used where the ectopic pregnancy is removed through two small holes in the lower abdomen.

In a tubal pregnancy, the tube attached to the fetus may be removed partially or completely to manage the bleeding ^[10]. Treating extra-uterine pregnancies in other locations also involve removing the fetus as well as repairing or removing any connected organs or tissues. Severe cases may also require blood transfusion ^[9].

A more invasive surgery, referred to as Laparotomy, may be necessary in emergency cases with severe internal injury ^[11].

Your hCG levels will be regularly monitored after the surgery to make sure there are no ectopic tissues left in your body. In 4%-8%of the cases where the tubes are spared after removing the fetus, some pregnancy tissues remain in the body ^[12], that continue to multiply, preventing the hormone levels from going down as expected. A methotrexate shot is necessary in such instances ^[13].

You will be given an anti-D immunoglobulin injection if you have rhesus negative blood, to prevent certain complications in future pregnancies ^[10].

Follow-up care and recovery after a surgery

Most women take around two weeks to recover from a keyhole surgery while an open surgery needs up to six weeks to recover from ^[8]. You may be allowed to leave the hospital a few days after the surgery ^[2], with specific guidelines for aftercare to be followed until you achieve complete recovery. It usually takes around 6 to 10 months for your regular periods to re-establish ^[14].

Getting pregnant after an ectopic pregnancy

In most cases, women have a normal pregnancy after an ectopic, even when one fallopian tube has been removed. There is around 60%-65% chance of getting pregnant again after an ectopic pregnancy ^{[15, 16]}, while the risk of recurrence is approximately 10% or higher ^[17]. Consult your doctor regarding how long you should wait after the treatment to start trying to conceive again. Most doctors recommend waiting for 3-6 months ^[18] after a methotrexate treatment so the drug can be completely out of your system ^[15]. Give yourself enough time to heal both physically and emotionally before trying again. You may need to consider IVF if both your tubes have been removed.

In case of an SPD, treating the disease as early as possible can minimize the chances of getting another ectopic pregnancy by preventing further damage to the fallopian tube. However, this treatment does not repair any damage already done to the tubes ^[18].

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