Treating ectopic pregnancy

Unfortunately, the baby cannot be saved in an ectopic pregnancy. Treatment isusually needed to remove the pregnancy before it grows too large.

The main treatment options are:

• expectant management your condition is carefully monitored to see whether treatment is necessary
• medication a medicine called methotrexate is used to stop the pregnancy growing
• surgery surgery is used to remove the pregnancy,usually along with the affected fallopian tube

These options each have advantages and disadvantages that your doctor will discuss with you.

They'll recommend what they think is the most suitable option for you, depending on factors such as your symptoms, the size of the pregnancy and the level of pregnancy hormone (humanchorionic gonadotropin or hCG) in your blood.

Expectant management

Ifyou have no symptoms or mild symptoms and the pregnancy is very small or can't be found, you may only need to be closely monitored, becausethere's a good chance the pregnancy will dissolve by itself.

This is known as expectant management and the following is likely to happen:

• You'll have regular blood tests to check that the level of hCG in your blood is going down these will be needed until the hormone is no longer found.
• You may need one of the treatments outlined below ifyour hormone level doesn't go down or it increases.
• You'll usually have some vaginal bleeding use sanitary pads or towels, rather than tampons, until this clears up.
• You may experience some tummy pain take paracetamol to relieve this.
• You'll be told what to do if you develop more severe symptoms.

The main advantage of monitoring is that you won't experience any side effects of treatment. A disadvantage is that there's still a small risk of your fallopian tubes splitting open (rupturing) and you may eventually need treatment.

Medication

If an ectopic pregnancy is diagnosed early but active monitoring isn't suitable, treatment with a medicine called methotrexate may be recommended.

Thisworks by stopping the pregnancy from growing and is given as a single injection into your buttocks.

You won't need to stay in hospitalafter treatment, but regular blood tests will becarried outto check if the treatment is working. A second dose is sometimes needed and surgery (see below) may be necessary if it doesn't work.

You need to use reliable contraception for at least three months after treatment, because methotrexate can be harmful for a baby if you become pregnant during this time.

It's also important to avoid alcohol until you're told it's safe, as drinking soon after receiving a dose of methotrexate can damage your liver.

Other side effects ofmethotrexate include:

• tummy pain this is usually mild and should pass within a day or two
• dizziness
• feeling and being sick
• Traveller's diarrhoea

There's also a chance of your fallopian tubes rupturing after treatment. You'll be told what to look out for and whatto do if you think this has happened.

Surgery

In most cases, keyhole surgery (laparoscopy) will be carried out to remove the pregnancy before itbecomes too large.

During a laparoscopy:

• you're given general anaesthetic , so you're asleep while it's carried out
• small cuts (incisions) are made in your tummy
• a thin viewing tube (laparoscope) and small surgical instruments are insertedthrough theincisions
• theentire fallopian tube containing thepregnancy is removed if your other fallopian tube looks healthy otherwise, removing the pregnancy without removing the whole tube may be attempted

Removing the affected fallopian tubeis the most effective treatment and isn't thought to reduce your chances of becoming pregnant again. Your doctor will discuss this with you beforehand and you'll be asked whether you consent to havingthe tube removed.

Most women can leave hospital a few days after surgery, although it can take four to six weeks tofully recover.

If your fallopian tube has already ruptured, you'll need emergency surgery. The surgeon will make a larger incision in yourtummy (laparotomy)to stop the bleeding and repair your fallopian tube, if that is possible.

After either type of surgery,a treatment calledanti-D rhesus prophylaxis will be givenif your blood type is RhD negative (see blood groups for more information). This involves an injection of a medicine that helps to prevent rhesus disease in future pregnancies.