What is the management of ectopic pregnancy?
Ectopic pregnancy is managed differently depending on the severity.
Ectopic pregnancy is usually managed through medications, surgery or observation. The type of management depends on the severity of the condition.
Conservative/observation management
The wait and watch approach is a safe and appropriate way to manage ectopic pregnancy. Managing the condition without treatment can feel quite scary, but it is good to give the body the best chance to resolve naturally. If a doctor suggested this method of treatment, then there is an almost 90% chance that the ectopic pregnancy will resolve all by itself. The patient would be observed closely until ectopic pregnancy is absorbed and there are minimal or no symptoms (like pain or bleeding). Nothing needs to be done in these circumstances except to ensure that the pregnancy hormone levels quickly return to normal. If monitored correctly, it may not be dangerous. However, there is still a very remote chance that the ectopic pregnancy may cause the fallopian tube to rupture and bleed. The observation management can be recommended when ectopic pregnancy has the following characteristics
- There is no or minimal pain.
- There is no blood in the abdomen.
- The embryo has already died.
- The embryo is very small.
- The pregnancy hormone level (HCG) is low and falling.
Medical or pharmacological management
Methotrexate is a chemotherapy drug that stops the pregnancy from growing. It is the medical treatment used to dissolve the ectopic pregnancy. If the ectopic pregnancy is small and the pregnancy hormone levels are not high, there is a 90% to 95% chance that using medical treatment would be safe. Methotrexate is given by a single injection in the arm. In certain situations, an infusion via a drip into the vein may be required. Pregnancy hormone levels would be monitored simultaneously. Side effects are temporary, which include abdominal pain, nausea, vomiting, indigestion, mouth ulcers, sensitivity to light or feelings of fatigue. Very rarely it can affect the liver or blood counts.
Surgical management
An operation is one way of treating an ectopic pregnancy. In emergency circumstances, this may be the only choice. The operation is usually performed under general anesthesia.
- In this procedure, the surgeon usually makes three small incisions in the abdomen. One is made inside the belly button and one or two incisions are made lower down on the abdomen.
- A thin, flexible instrument with a camera and light source on its end (laparoscope) is inserted through the incision in the belly button to allow the surgeon to see what they are doing. If an ectopic pregnancy is confirmed, the tube is usually removed.
- Sometimes, it may be possible to make a cut in the tube and remove the pregnancy leaving the tube intact. The downside of this is that sometimes not all the pregnancy tissue is removed. Further, this tube may be damaged and there is an increased chance of another ectopic pregnancy occuring in that tube in the future.
- While most operations for ectopic pregnancy are done using a laparoscopic or keyhole surgery, sometimes an open operation needs to be performed. This is more likely if the patient has had a lot of bleeding or if the keyhole surgery is not technically possible.
- For keyhole surgery, the patient may need to stay for just a day in the hospital. For open surgery, the patient may need to stay for 2 to 4 days.
What is an ectopic pregnancy?
Ectopic pregnancy is the medical condition in which the implantation of an embryo occurs outside of the uterine cavity (the womb), most commonly in the fallopian tube. Hence, an ectopic pregnancy is also called a tubal pregnancy. It is a potentially serious condition affecting at least one in 1,000 pregnancies. Sadly, there is no possibility that pregnancy can survive. Below are a few risk factors
- History of infertility
- History of previous ectopic pregnancy
- History of pelvic infection or and tubal damage
- History of pelvic surgery, including sterilization
- Previously used an intrauterine contraceptive device (IUCD)
- Undergoing assisted conception, such as in vitro fertilization (IVF)
- Hormonal imbalance, malfunction of the uterus and tube and infection can impair the tube’s normal function and result in ectopic pregnancy.
- Poor lifestyle habits like smoking or drinking alcohol may also lead to ectopic pregnancy.
The early symptoms of an ectopic pregnancy may be very similar to typical pregnancy symptoms which include
- Vaginal bleeding
- Pain in the lower abdomen, pelvis and lower back
- Dizziness or weakness
If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause additional symptoms. These can include
- Fainting
- Low blood pressure (hypotension)
- Shoulder pain
- Rectal pressure
When a tube bursts, the patient may feel sharp lower abdominal pain. This is a medical emergency and the patient may need to seek medical help immediately.