Treating an ectopic pregnancy
If you have been diagnosed as having an ectopic pregnancy and are stable, with pulse and blood pressure within normal limits, and there is no heavy bleeding or severe pain, and if there are no signs of dizziness or fainting, your doctor will be able to discuss various treatment options with you.
Unfortunately, a number of women have no early symptoms so present for assessment after a time when there are still options available for treatment. If you are bleeding heavily, in severe pain or have signs of dizziness or fainting, your doctor will probably suggest an exploratory surgical operation called a laparoscopy which is done via keyhole surgery to allow them to take a look inside your abdomen to see what might be happening.
New treatment methods are being developed but set out below are the options that you are likely to be currently advised. An Ectopic Pregnancy can also be treated by Surgical management or Medical management with methotrexate.
The term ‘expectant management’ is usually defined as watchful waiting or close monitoring by medical professionals instead of immediate treatment.
Research has shown that, in patients 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.
In deciding whether expectant management was appropriate, doctors would first review the results of blood tests, ultrasound scan(s) and undertake an assessment of your general health. Expectant management would then be considered for treatment when:
- The hormone being made by the pregnancy (beta hCG) is low
- General health appears to be stable
- Pain levels are considered to be acceptable
- An ultrasound scan shows a small ectopic pregnancy with no worrying bleeding into the abdomen
Doctors would then want to test your blood repeatedly to ensure that your hCG levels are dropping, usually twice in the first week and then weekly thereafter until the levels have dropped to below 5<mIU/mL. It is not usually necessary to do another ultrasound scan unless you present with other symptoms, in which case your doctors will undertake a reassessment.
How long you need to keep attending the hospital for repeat tests will depend upon how long it takes for your hCG levels to drop to below 5<mIU/mL and this timeframe can vary quite considerably. As a general rule, as long as your hCG levels are dropping between blood tests, your doctors will continue to monitor you and manage you expectantly. It can take anything between two weeks and three months, for your hCG levels to fall back to a non-pregnant level but, for most, hCG levels have reached a non-pregnant state within around four weeks.
In these circumstances, your hospital would give you a number to contact for health advice if you feel that anything is changing, or you will have been told to report to the Accident and Emergency Department (A&E). If you have not been told what to do and need to speak to someone ring the hospital department which is treating you or the NHS 111 Service by dialing 111.
Why does my doctor want to treat me with expectant management and not give me medication or surgery?
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 recovery will be faster.
At the EPT we strongly believe in patient choice and that you should also be able to elect for treatment rather than watching and waiting if you do not feel this option is emotionally suitable for you.
What are the risks of being managed expectantly?
The main risk associated with expectant management is that the cells of the ectopic pregnancy might continue to divide, which could result in there still being a need for medical treatment or surgery after a time of having expectant management. Around 25% of women who are expectantly managed initially go to on to need medical or surgical treatment. Doctors can tell if the specialised cells of a pregnancy that produce the hCG hormone are dividing because the hCG level as shown through the blood tests will rise and not fall.
Occasionally an ectopic pregnancy can rupture despite low hCG levels. If you are concerned about your level of pain, please contact your hospital.
How will I know if there is a problem and I need a different treatment?
Your doctors will be able to tell if your pregnancy is not resolving, as this will be shown in the results of the regular blood tests. If this is the case, they will suggest other forms of treatment for you. The symptoms of a deteriorating ectopic pregnancy, which include worsening or progressively increasing pain; vaginal bleeding; shortness of breath; feeling faint; and pain in the tip of the shoulder among others, may become noticeable.
If you suffer any of these symptoms you will need to be reassessed. Your hospital would give you a number to contact for health advice if you feel that anything is changing, or you will have been told to report to the Accident and Emergency Department (A&E). If you have not been told what to do and need to speak to someone ring the hospital department which is treating you or the NHS 111 Service by dialing 111.
What can I do to help this kind of management work for me?
It is important that you do not undertake any strenuous exercise or lift heavy weights while hCG levels are dropping.
You should avoid sexual intercourse until your hCG is down to a non-pregnant level.
Stop taking folic acid supplements and avoid any other vitamin and/or mineral supplements until the hCG levels confirm that the ectopic pregnancy has ended.
It is important to take things gently in the first few days after your diagnosis until it can be established that the hCG levels are dropping on their own.
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