What Is the Treatment Process for Ectopic Pregnancy?

In an ectopic pregnancy, the fertilized egg never reaches the uterus. Instead, it implants somewhere else in the body, most often in the fallopian tube. Ectopic pregnancies never result in a baby because the uterus is the only environment suited for fetal development.

Seeking treatment early can help prevent life-threatening complications from an ectopic pregnancy. Early diagnosis might also mean you have more non-invasive treatment options.

An overview of ectopic pregnancies

It’s a rare condition that occurs in just 1 percent to 2 percent of all pregnancies. The exact cause of ectopic pregnancies is unknown, but several factors can increase your risk.

The risk factors of an ectopic pregnancy include:

• Having a previous ectopic pregnancy
• Previous fallopian tube, pelvic or abdominal surgery
• Pelvic inflammatory disease (PID)
• Some sexually transmitted infections (STIs)
• Endometriosis

Other factors linked to a higher chance of ectopic pregnancy include smoking, using assisted reproductive technology such as in vitro fertilization (IVF) and being older than 35. 

Treatments for ectopic pregnancy

Leaving an ectopic pregnancy untreated is incredibly dangerous. The growing pregnancy can stretch the fallopian tube until it bursts and causes internal bleeding.

Once your doctor diagnoses an ectopic pregnancy, they will recommend a plan for removing the ectopic tissue. Your options will depend on your symptoms and how early the ectopic pregnancy was discovered.

Medication

If your ectopic pregnancy is found early, you might be a good candidate for medical treatment instead of surgery. This involves using a needle to inject a medication called methotrexate. Doctors typically give this shot in the butt, leg or arm.

Methotrexate stops pregnancy cell development, explained Sarah Yamaguchi, M.D., a gynecologist at DTLA Gynecology in Los Angeles. It's a low-risk treatment and is often just one dose.

Conditions must be suitable for a doctor to recommend methotrexate. Parameters include the following:

• The doctor must confirm that the pregnancy is early, ectopic and unruptured.
• Your blood flow and hemoglobin levels should be within the normal range.
• You'll need to be available for a follow-up test to confirm that the treatment worked (and get another injection if it didn't).

"Some women do not have the resources to follow up for the monitoring that is needed," Yamaguchi said, adding that if you're unable to commit to a follow-up appointment, methotrexate is not the best treatment for you.

Aside from the risk of needing another injection, you should be aware of common methotrexate side effects. These include:

• Cramping
• Fatigue
• Nausea
• Diarrhea
• Headache
• Trouble sleeping

Speak with your doctor if you have any questions or concerns.

Laparoscopic procedures

Salpingectomy and salpingostomy are two laparoscopic procedures used to treat ectopic pregnancies. In laparoscopic surgeries, the doctor makes tiny abdominal incisions through which the procedure is performed instead of a large one. The procedure is completed with the help of a camera.

"Surgery is used for treatment when conservative treatment with methotrexate is likely to fail or if the patient is actively bleeding in the pelvis," Yamaguchi said.

In a salpingectomy, your entire fallopian tube is removed. The primary benefit is knowing the ectopic tissue is absolutely gone, Yamaguchi noted. However, a salpingectomy also means your fallopian tube is no longer functional. This can be a concern for women who want to have a baby but have damage to the other fallopian tube.

In a salpingostomy, only the ectopic tissue is removed from the fallopian tube.

"There is the risk of ectopic pregnancy happening again and also the risk that all the ectopic pregnancy tissue wasn't removed," Yamaguchi said. To mitigate these risks, doctors monitor hormone levels post-salpingostomy.

Whether you get a salpingectomy or salpingostomy, follow your doctor's aftercare instructions. Be aware of potential risks and side effects such as pain, fatigue, bleeding and infection.

Emergency surgery

Sometimes an ectopic pregnancy becomes a medical emergency. When growing tissue causes the fallopian tube to burst, the abdomen can fill with blood. In this case, the doctor will opt for emergency laparoscopic or abdominal surgery.

Emergency surgeries are never ideal. Recovery can be physically and emotionally challenging. Any major surgery carries a risk of shock, bleeding, infection and reaction to anesthesia.

Risks of untreated ectopic pregnancy

Experiencing pregnancy loss can be heartbreaking. Facing an unwanted pregnancy of any kind can be an emotional rollercoaster. If you're feeling emotional about the possibility of an ectopic pregnancy, seek support.

It is very rare for an ectopic pregnancy to "die off" on its own, Yamaguchi said. She also warned against self-treatment, such as Plan B, which will not resolve an ectopic pregnancy. The more time you allow to pass without medical intervention, the higher the odds of a life-threatening emergency.

"Waiting it out could mean fainting in your bathroom and having your roommate or partner find you passed out," she said. "You get emergency surgery with Grey's Anatomy-style dramatics, with full replacement of your blood supply since you have lost the majority of your blood into your abdomen. Or you could take one injection of methotrexate or have a minimally invasive surgery. I know which I would pick."

Can ectopic pregnancy be prevented?

Unfortunately, you cannot prevent an ectopic pregnancy while also trying to have a baby.

Ectopic pregnancy requires medical treatment. Don’t delay a visit to your doctor. Putting it off could result in a trip to the emergency room. If you suspect you have an ectopic pregnancy, consult a doctor immediately.