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Ectopic pregnancy is a pregnancy that starts outside your womb. In most cases, the sac that contains the fertilized egg is stuck in one of your fallopian tubes. This is also called a tubal pregnancy. Ectopic pregnancy occurs in about 1-2 percent of pregnancies. Ectopic pregnancies can’t develop into successful pregnancies.
There is a danger that an ectopic pregnancy will grow until it ruptures. This can cause life-threatening bleeding. Before the mid-1980s, all ectopic pregnancies were treated with surgery. Today, many ectopic pregnancies can be treated with medication, and a few can be treated with watchful waiting.
There are risks and benefits to all these treatments. The best choice for you will depend on the state of the ectopic pregnancy. In some cases, you may have options. Let’s take a look at the three treatments and the risks and benefits of each.
Watch full Waiting: Expectant Management
The most common symptoms of ectopic pregnancy are abdominal pain and abnormal bleeding during you first trimester. Ectopic pregnancies also happen in women who do not know they are pregnant, so these symptoms always need to be investigated.
To diagnose ectopic pregnancy, your doctor will do blood tests to measure a hormone that goes up during pregnancy called human chorionic gonadotropin (hCG). Your doctor will also do a sound wave imaging study (ultrasound) that shows the pregnancy forming outside your womb.
To consider expectant management, your ectopic pregnancy needs to be small and your hCG needs to be low and falling. In these cases, there is a good chance your body will abort the pregnancy and absorb it. The benefit of this option is that you avoid treatment and the side effects or complications that go with treatment.
The big risk is that you may have a rupture of the ectopic pregnancy while you are waiting. You may also still need treatment if your body does not abort and absorb. Treatment for a rupture is surgery. If your doctor thinks waiting is safe for you, you will be monitored frequently to make sure your hCG continues to fall until it reaches zero.
Methotrexate is a drug used to treat cancer. It works by blocking the DNA in quickly growing cells. The cells stop dividing and growing. Cancer cells grow quickly and so do the cells of an ectopic pregnancy.  Methotrexate may be an option for you if your ectopic pregnancy is not too big and your hCG is not too high. Methotrexate is not a good choice if the pregnancy sac is large or the hCG is high. It is not a good choice if there is the beginning of fetal heart activity, or you have a condition that methotrexate may make worse. These include:
- Liver disease
- Kidney disease
- Peptic ulcer
- Lung disease
- A blood disorder
- A weak immune system
If you choose this treatment, you will need to avoid alcohol, sexual intercourse, vitamins with folic acid, and nonsteroidal anti-inflammatory drugs (NSAIDs) until your doctor gives you the all clear. This drug is usually given as one injection into a muscle. After the injection, your doctor will check your hCG levels to make sure they are falling. You may need another injection if your hCG is not falling quickly enough. If treatment fails, you may still need surgery. Your hCG levels will be checked until they hit zero.
The main advantage of this treatment is that it may be as successful as surgery if you are a good candidate. You avoid the risks of surgery and the recovery from surgery. The big risk is that treatment does not work or your pregnancy ruptures. After your in injection, it will be important to let your doctor know right away if you have symptoms of rupture such as bleeding or increasing abdominal pain.
Methotrexate also has some side effects you should know about. The most common are:
- Abdominal pain
- Nausea and vomiting
- Mouth soreness
Surgery is the best option if you are bleeding actively or your ectopic pregnancy ruptures. You may need an emergency, open surgery called a laparotomy. In these cases, the ectopic pregnancy is usually removed along with the fallopian tube. This is called a salpingectomy.
If there is no bleeding or rupture, you may choose an elective surgical procedure called a laparoscopy. This procedure is done through small incisions using and operating telescope with a camera. In most cases, your surgeon will be able to remove the ectopic pregnancy without removing the fallopian tube. This is called salpingostomy.
Sometimes a salpingectomy is done during laparoscopy. Sometimes laparoscopy needs to be changed to laparotomy. This can happen if there is a rupture or bleeding during the procedure, or if the ectopic pregnancy is too hard to see and remove through the scope.
The advantages of either surgery are a high success rate and the ability to treat women who are not good candidates for methotrexate. Salpingectomy may be the better choice for you if:
- You do not want to have more children.
- Your fallopian tube is scarred or damaged.
- You have had a previous ectopic pregnancy in the same tube.
Disadvantages of surgery include:
- Risks of anesthesia
- Risk of bleeding or infection from the surgery
- Risk of scar tissues called adhesions
- More pain after treatment
- A longer recovery after treatment
Adhesions can increase your risk for a future ectopic pregnancy and may decrease your ability to get pregnant. If you have a salpingectomy, you may have less chance of future pregnancy. Laparoscopy has less anesthesia risk, a quicker recovery, and a lower risk of bleeding or infection than laparotomy.
Surgery is no longer the only treatment for ectopic pregnancy. Depending on the state of the ectopic pregnancy, you may be able to choose between surgery, medication, or expectant management. All of these have risks and benefits. Ask your doctor to help you choose the treatment that is best for you.