Treating an Ectopic Pregnancy

Surgical treatment

Surgical management is the most established form of treatment and means performing an operation to remove the ectopic pregnancy while you are under general anaesthetic.

In most circumstances, the type of operation is through a technique called laparoscopy (keyhole surgery). This involves inserting a camera through the navel (belly button) and inserting instruments through two small cuts in the lower abdomen (tummy). A small amount of gas is put into your abdominal cavity to inflate it to enable the surgeon to see inside the abdomen.

Historically, surgery can also involve a laparotomy (an open cut) on the lower abdomen, just above the bikini line. This type of procedure is still occasionally needed if there is heavy internal bleeding/rupture or a lot of scar tissue and is performed as an emergency surgery.

If the hormone being made by the pregnancy (beta hCG) is high, the ectopic pregnancy is large, or significant internal bleeding has been seen on your scan, doctors cannot consider less invasive treatments because your health may be at immediate risk and therefore surgery becomes the only route available. Surgery may also be performed if expectant management or medical management has not been effective.

Keyhole surgery (laparoscopy) is less physically invasive than open surgery (laparotomy).

Medical treatment with methotrexate

The term ‘medical management’, when used in relation to ectopic pregnancy, means using a drug called methotrexate. The drug stops the pregnancy developing any further and it is gradually reabsorbed by the body, leaving the Fallopian tube intact. Methotrexate is most effective in early ectopic pregnancy, usually when the pregnancy hormone ‘beta hCG’ level is below 5000 mIU/mL.

The treatment is given by means of an injection. It is usually a single injection into the muscle of your bottom, however, if it needs to be administered by any other route, this will be discussed with you. The dose is calculated according to your height and weight. Before the injection, blood tests are done to check liver and kidney function and to ensure that you are not anaemic.

This method has been developed to avoid surgery. However, it does require careful monitoring and follow-up. This means that you will have to attend the hospital regularly for blood tests to monitor your hCG levels until the tests are negative. This can take several weeks, and this will be explained by your doctor. Your hospital will make arrangements for you to have the hormone level checked. Your doctors will usually test your hCG levels on the day the medicine is given, again on day four, and on day seven after the injections.

Expectant management

The term ‘expectant management’ is usually defined as watchful waiting or close monitoring by medical professionals instead of immediate treatment. It can also be known as conservative management.

Research has shown that, in pregnant women with an ectopic pregnancy who are properly assessed and their pregnancy hormone level (beta hCG) is dropping, up to 50% of these pregnancies will end naturally and there will be no need for an operation or a drug to treat the condition.

Doctors always consider the least invasive form of treatment or management first where they can. Research-based evidence has shown that in properly selected patients, a proportion with a diagnosed or suspected ectopic pregnancy will need no active treatment and it will resolve on its own through watching and waiting. Although this can feel nerve-wracking and as though no one is doing anything, if the pregnancy does resolve on its own, avoiding surgery or powerful drug treatments, means your physical recovery will be faster.

In deciding whether expectant management is appropriate, doctors would first review the results of blood tests and transvaginal ultrasound scan(s) and undertake an assessment of your general health.