In most cases, an ectopic pregnancy is treated right away to avoid rupture and severe blood loss. The decision about which treatment to use depends on how early the pregnancy is detected and your overall condition. For an early ectopic pregnancy that is not causing bleeding, you may have a choice between using medicine or surgery to end the pregnancy.
Medicine. Using methotrexate to end an ectopic pregnancy spares you from an incision and . But it does cause side effects and can take several weeks of hormone blood-level testing to make sure that treatment has worked. Methotrexate is most likely to work:
- When your pregnancy hormone levels (human chorionic gonadotropin, or hCG) are low (less than 5,000).
- When the embryo has no heart activity.
Surgery. If you have an ectopic pregnancy that is causing severe symptoms, bleeding, or high hCG levels, surgery is usually needed. This is because medicine is not likely to work and a rupture becomes more likely as time passes. When possible, surgery that uses a small incision is done. For a , emergency surgery is needed.
Expectant management. For an early ectopic pregnancy that appears to be naturally miscarrying (aborting) on its own, you may not need treatment. Your doctor will regularly test your blood to make sure that your pregnancy hormone (hCG, or human chorionic gonadotropin) levels are dropping. This is called expectant management.
Ectopic pregnancies can be resistant to treatment.
- If hCG levels do not drop or bleeding does not stop after taking methotrexate, your next step may be surgery.
- If you have surgery, you may take methotrexate afterward.
If your blood type is , Rh immunoglobulin is used to protect any future pregnancies against . For more information, see the topic Rh Sensitization During Pregnancy.
What to think about
Surgery versus medicine
- Methotrexate is usually the first treatmentchoice for ending an early ectopic pregnancy. Regular follow-up blood tests areneeded for days to weeks after the medicine is injected.
- There aredifferent types of surgery for a tubal ectopic pregnancy-when possible, only aslit is made in the fallopian tube (salpingostomy), rather than removing asection of the tube (salpingectomy).
- On average, salpingostomy isequal to methotrexate (for an early ectopic pregnancy) in terms of beingeffective and preserving a woman's ability to become pregnant in thefuture.3
- Although surgery is a faster treatment, it can cause scartissue that could cause future pregnancy problems. Tubal surgery may damage thefallopian tube, depending on where and how big the embryo is and the type ofsurgery needed.
Surgery may be your only treatment option if you have internal bleeding.