A fertilized egg can’t develop physiologically outside the uterus. The ectopic tissue must need removal, as they may lead to life-threating consequences.
Treatment options are classified as;
- Expectant management
If the patient has mild symptoms and the pregnancy is very small, she may need only monitored closely, as there is a possible option that pregnancy will dissolve by self. In patients with an ectopic pregnancy who are monitored properly and their beta hCG level is dropping, then there is a possible chance that 50% of these pregnancies will end naturally with no need of medical or surgical treatment.
Suggestions for expectant management are;
- beta hCG level is low
- Pain levels are acceptable, which indicates that the problem is manageable
- stable general health of the patient
- A small ectopic pregnancy on ultrasound with no or very less bleeding
Patient’s blood is repeatedly tested (twice in the first week). As long as the patient’s hCG is dropping, doctors will continue monitoring and will manage expectantly.
Treatment with a drug methotrexate may be recommended. Mechanism of action is stopping the pregnancy by stopping the cells from growing and dissolving the existing cells, as folate is needed for rapidly dividing cells in pregnancy and methotrexate works by temporarily interfering with the processing of folate in the body. Methotrexate is administered as a single intramuscular injection. In case of no response, a second dose is needed sometimes. Side effects of methotrexate includes tummy pain, fatigue, vaginal bleeding or spotting, dizziness and diarrhea.
If medicine therapy does not work, surgery is the next option. An ectopic pregnancy can be treated with laparoscopic surgery. A small incision is made in the abdomen. A laparoscope is inserted through the incision. Salpingotomy (repairing of the tube) or salpingectomy (removing of the tube) is attempted.
If the ectopic pregnancy cause heavy bleeding due to tube rupture, to the abdomen. This will lead to an emergency condition and the consequences will compel the surgeon to do the laparotomy.