Ectopic Pregnancy Treatment
Treatment of a pregnancy developing outside the uterus, with management based on its location, size and the patient’s condition
What is ectopic pregnancy treatment?
An ectopic pregnancy is one that has implanted somewhere other than the lining of the uterus, and in the great majority it is in a fallopian tube. The tube has no capacity to expand with a growing pregnancy and no lining built to support one, so the pregnancy cannot continue wherever it has landed.
As it grows it stretches the tube, and if it is not dealt with the tube can tear. That tears blood vessels with it, and bleeding into the abdomen from a ruptured tube is rapid and is the reason this is treated as an emergency and not as something to review next week.
The risk is higher after previous tubal damage, after a previous ectopic pregnancy, after pelvic infection, with endometriosis, and where conception happened with a coil in place. In about half of cases there is no risk factor at all, and it happens to a woman with nothing in her history to suggest it.
What you might notice
- Bleeding and cramping in early pregnancy
- Pelvic pain
- A missed period and a positive pregnancy test
How it is diagnosed
Two things make the diagnosis together: a pregnancy test and a transvaginal scan. Where the test is positive and the scan finds nothing in the uterus, the pregnancy is somewhere, and it is treated as ectopic until proven otherwise.
Serial hCG levels forty-eight hours apart are what resolve the uncertainty when it is too early to see anything. A healthy pregnancy in the uterus roughly doubles the level over that interval; a plateau or a slow rise points elsewhere. A single value in isolation answers very little.
Suspicion is the whole game. Any woman of reproductive age with lower abdominal pain gets a pregnancy test at the door, and a missed or unusually light last period is worth saying even when you are sure you are not pregnant.
Recovery
Medical treatment means an injection and then weeks of blood tests until the level reaches zero, which takes four to six weeks and sometimes a second dose. Alcohol and certain vitamin supplements are stopped during it, and it is a slower course than surgery, done as an outpatient.
After keyhole surgery most women are home within a day or two and back to normal in two weeks. Where there was heavy bleeding into the abdomen and a transfusion was needed, it takes longer and the tiredness lasts several weeks beyond the incisions healing.
Most guidance is to wait three months before trying again, both to let the tissues heal and to be certain the levels have fully cleared, and to have an early scan in the next pregnancy to confirm where it has implanted. The emotional recovery generally runs longer than the physical one, and this was a pregnancy that was lost, which is worth saying out loud to someone.
If it is left untreated
This is the one situation in gynaecology where waiting to see what happens is not a safe plan. A pregnancy in a tube that is left alone stretches it until it tears, and the bleeding that follows is into the abdomen where there is nothing to stop it. That is a genuine threat to life and it can develop over hours.
There is a narrow exception, and it is a supervised one. Where the hormone level is low and already falling on repeated tests, and you are stable and can get back quickly, a doctor may follow the levels to zero without any treatment, because a small proportion resolve on their own. That is a monitored course with blood tests every few days and clear instructions, and it is not the same as waiting at home to see how you feel.
Delay also costs the tube. A tube dealt with before it ruptures can sometimes be opened and kept; one that has torn almost always has to come out, and that matters for conceiving later.
Questions about ectopic pregnancy treatment
Can the pregnancy be saved?
No. There is no way to move a pregnancy from a tube into the uterus, and the tube cannot support it as it grows. That is a genuinely hard thing to be told, and it is worth knowing that it is not a matter of acting quickly enough or of choosing the right hospital. What treatment decides is your own safety and how much of your future fertility can be protected, and the choice between medication and surgery is made on how stable you are, how high the hormone level is and what the tube looks like.
Will I be able to get pregnant again?
Most women can and do. Where one tube is removed and the other is healthy, the remaining tube collects eggs from both ovaries and conception rates afterwards are good, though it may take a little longer. Where the surgeon was able to open the tube and leave it in place, there is a small chance of pregnancy tissue persisting, so the hormone level is followed until it reaches zero. The pattern that most affects the outlook is damage to both tubes, from previous infection or a previous ectopic, and in that situation IVF bypasses the tubes entirely. The usual advice is to wait about three months before trying again, and to have an early scan next time to confirm where the pregnancy has implanted.
What are the warning signs I should not wait on?
Severe or one-sided lower abdominal pain, pain in the tip of the shoulder, feeling faint or actually fainting, or a racing pulse in early pregnancy need emergency assessment the same hour, because they suggest bleeding into the abdomen from a tube that has torn. Do not wait for a scheduled appointment and do not drive yourself. Lighter warning signs that still warrant being seen the same day are a positive pregnancy test with any pelvic pain, or bleeding that differs from a normal period when a period is late. Say that you are or might be pregnant at the reception desk, since it changes how quickly you are seen.
Other obstetrics & gynaecology treatments
Delivery of a baby through surgery when vaginal delivery is not advisable or safe
InpatientManagement of non-cancerous growths in the uterus, based on symptoms, size, location and reproductive plans
Day CareTalk to a care coordinator about ectopic pregnancy treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one