Treatment of ectopic pregnancy
All the options for treatment lead to the end of the ectopic pregnancy, which would not be able to develop normally.
Your treatment will depend on how severe your symptoms are, how advanced your pregnancy is and whether or not your fallopian tube has ruptured. Your doctor should also discuss with you if you plan to get pregnant again in the future.
Here we describe the treatment options for an ectopic pregnancy in the fallopian tubes – by far the most common kind. If you have an ectopic pregnancy in another site, your doctor will talk to you about the possible treatment options.
Watchful waiting (expectant management)
You might not need any treatment for an ectopic pregnancy because sometimes the pregnancy ends by itself. Before deciding that this is a safe option for you, your doctor will check that:
- the mass in your fallopian tube is smaller than three-and-a-half centimetres
- you have no pain and there isn’t anything else causing your doctor concern
- your blood test shows the level of hCG is low and falling
- you’re happy to agree to the necessary monitoring by the hospital
Your doctor will ask you to have regular blood tests for hCG until it is no longer detectable. You don’t have to stay in hospital, but you should go back if you have any more symptoms.
Expectant management is successful for between seven and nine out of every 10 women who have it. If it doesn’t work for you, you can go on to have medical treatment or even surgery if necessary.
Medical treatment for ectopic pregnancy involves one or more injections of a medicine called methotrexate. This stops the growth of the embryo cells and the pregnancy is gradually absorbed by your body. Methotrexate treatment is only suitable if your pregnancy is still in the early stages.
After your injection, you’ll need to return for further monitoring of your hCG levels. Depending on the results, you may need another dose of methotrexate. You’ll have blood tests until hCG is no longer found in your blood. This can take up to eight weeks.
Treatment with methotrexate has side-effects. It often causes abdominal pain two or three days after the injection, and may cause sickness and diarrhoea.
It’s important not to get pregnant again within three months of having a methotrexate injection. If you become pregnant, methotrexate may harm your developing baby.
Some women can’t have treatment with methotrexate because of their general health. If you can’t have methotrexate or if treatment is unsuccessful, your doctor will suggest treatment with surgery.
You may need surgery to remove your fallopian tube and ectopic pregnancy if:
- medicines haven’t worked or you wouldn’t be able to keep going back for follow up tests after medical treatment
- your pregnancy is larger than three-and-a-half centimetres across
- you have severe pain
- you are very unwell because your fallopian tube has ruptured and you have internal bleeding – this is a medical emergency
Usually, you’ll have keyhole surgery using a laparoscope and be under general anaesthesia. The laparoscope is put into your body through a small cut or cuts in your abdomen. However, in some circumstances, a larger cut is needed for your doctor to see the affected area directly. This is called open surgery or a laparotomy.
Surgery usually involves removing the whole affected fallopian tube (salpingectomy). This is usually the case if you don’t plan to become pregnant again or if you do want further pregnancies and your other tube is healthy.
If your other fallopian tube is damaged or you have other reasons for low fertility but do want another pregnancy, removing just the ectopic pregnancy may be an option. This is called a salpingotomy. It gives that tube a chance to work normally again in future.
If you have a salpingotomy, you’ll need to have follow-up tests to check your hCG levels. There’s a chance you’ll need to have the fallopian tube removed in future or have further treatment with methotrexate. See our medicines section for more information.