Treatment of Ectopic Pregnancy
An ectopic pregnancy is when a pregnancy starts to grow outside the uterus.
The symptoms of an ectopic pregnancy include:
Abnormal bleeding : You may have some spotting or bleeding that is different from your normal period. The blood may be darker and more watery.
Pain in your lower abdomen : This may develop suddenly for no apparent reason or may come on gradually over several days. It may be on one side only.
Pain in the tip of your shoulder : This occurs due to blood leaking into the abdomen. This pain is there all the time and may be worse when you are lying down.
Severe pain/collapse
If the fallopian tube ruptures and causes internal bleeding, you may develop intense pain or you may collapse. This is an emergency situation. In rare instances,
collapse is the first sign of an ectopic pregnancy.
Ultrasound scan
Most women are offered a transvaginal scan (where a probe is gently inserted into your vagina) to look at the uterus, ovaries and fallopian tubes. If you are in the early stages of pregnancy, you may be offered another scan after a few days when it may be easier to see the pregnancy.
Blood tests
A test for the level of the pregnancy hormone human chorionic gonadotrophin (hCG) or a change in this level every few days may help to give a diagnosis.
Surgery
The aim of surgery is to remove the ectopic pregnancy. The type of operation you have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation (laparoscopy). To have the best chance of a future pregnancy inside your uterus, and to reduce the risk of having another ectopic pregnancy, you will usually be advised to have your fallopian tube removed (salpingectomy). If you only have one tube or your other tube does not look healthy, this already affects your chances of getting pregnant. In this circumstance, you may be advised to have a different operation (salpingotomy). This operation aims to remove the pregnancy without removing the tube. It carries a higher risk of a future ectopic pregnancy but means you retain the possibility of a pregnancy in the uterus in the future. Some women may need to have a further operation to remove the tube later if the pregnancy has not been completely removed.
An operation to remove the ectopic pregnancy will involve a general anesthetic.
The surgery will be either:
Laparoscopy
We use a small telescope to look at your pelvis by making a tiny cut usually into the umbilicus (tummy button). This is also called keyhole surgery. One or two cut of 0.5 to 1cm may be given. The stay in hospital is about 1 to 2 days and the recovery is about 2 to 4 weeks.
Open surgery : Rarely required known as a laparotomy – is performed through a larger cut in your lower abdomen. It is usually done if severe internal bleeding is suspected. You will need to stay in hospital for 2 to 4 days. It usually takes about 4 to 6 weeks to recover.
Expectant management (wait and see)
Ectopic pregnancies sometimes end on their own – similar to a miscarriage. Depending on your situation, it may be possible to monitor the hCG levels with blood tests every few days until these are back to normal. Although you do not have to stay in hospital, you should go back to hospital if you get any symptoms. You can contact us directly in such situations. Up to 29 in 100 (29%) women undergoing expectant management may require additional medical or surgical management.
Medical treatment
In certain circumstances, an ectopic pregnancy may be treated by medication (drugs). The fallopian tube is not removed. A drug (methotrexate) prevents the pregnancy from developing and so the ectopic pregnancy gradually disappears. The drug is given as an injection. If your pregnancy is beyond the very early stages or the hCG level is high, methotrexate is less likely to succeed. Many women experience some pain in the first few days, but this usually settles with paracetamol or similar pain relief. Although long-term treatment with methotrexate for other illnesses can cause significant side effects, this is rarely the case with one or two injections to treat ectopic pregnancy.
You may need to stay in hospital overnight and then return to the clinic or ward a few days later. It may be sooner if you have any symptoms. It is very important that you attend your follow-up appointments. Fifteen in 100 (15%) women need to have a second injection of methotrexate. Seven in 100 (7%) women will need surgery, even after medical treatment.
