Ectopic Pregnancy

Ectopic pregnancy is a pregnancy that occurs outside of the uterus. It is a potentially life threatening situation but it can be treated successfully with surgery or medication.

Ectopic pregnancy happens when the fertilized egg does not implant in the uterus. The most common location for an ectopic pregnancy is the fallopian tube. The danger is that the baby begins to grow and becomes too big for the confines of the tube. The tube will then bust and this can cause life threatening bleeding.

Ectopic pregnancy will cause significant pain usually in one side or the other of the lower abdomen or pelvis. Some cramping and even some sharp pains are common in early pregnancy, but if you experience significant pain you should get medical help immediately. Bleeding or spotting is also common with ectopic pregnancies, but bleeding is not always present.

Traditionally, ectopic pregnancy has been treated with surgery to remove the ectopic embryo and often the tube. More recently a treatment option has been developed to treat ectopic pregnancies with medication.

The surgery can often be done laparoscopically.This type of surgery is done with a camera through a small hole in your belly button and one or two other small holes in your abdomen. When done this way the recovery from the surgery is much less significant. For various reasons a laparoscopic approach may not be safe and the surgery may need to done with a larger incision in the abdomen. This will require a 4-6 week recovery.

Methotrexate is the medication that can often be used to treat ectopic pregnancies. The earlier the ectopic pregnancy gets diagnosed the more likely methotrexate can be used. Some of the advantages of treating with methotrexate rather than surgery are avoiding surgery and increasing the chances of preserving the tube thus increasing the chance of being able to have more children in the future.

Methotrexate is given as a single injection although occasionally a second injection will need to be given one week after the first. Methotrexate is also used as a chemotherapy drug for patients with some forms of cancer. When it is used as chemotherapy, it is used in much larger doses and can have significant side effects. Side effects in the small dose used for ectopic pregnancies are very rare.

The methotrexate will take several days before it completes its effect. Pain may continue and even worsen for several days. There is a chance that the medication will not work so if symptoms get significantly worse immediate medical attention is required. It will be important to have close follow up after getting the methotrexate. Pregnancy hormone blood levels will need to be followed to be sure the ectopic pregnancy has resolved.

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