Advances in Ectopic Pregnancy Care
Saving maternal life and fertility
Once a pregnancy is discovered to be ectopic, doctors work with patients to determine the best course of action to remove the fetus without further harming the fallopian tube. Several different treatments exist, including medication and surgery. Dr. Klugman points out, “Medications, such as methotrexate, are used much more frequently lately as we are ‘catching’ ectopic pregnancies earlier with the more frequent use of early sonograms and early pregnancy tests. Treatments are based on the patient’s symptoms.”
While some patients experience abdominal pain and bleeding (or hemorrhage) and head to their gynecologist, other women, especially those seeking fertility treatment, may have no obvious symptoms in the beginning of an ectopic pregnancy. Other women miscarry these pregnancies. This may appear as an “ordinary” miscarriage.
“If the patient is without symptoms, her hormone level is not too high, and if the gestational sac is not too large, methotrexate is used to help break up the pregnancy tissue. This treatment, which is [used for] 90 percent of patients, may take several weeks to resolve.” Dr. Trolice says, adding that early treatment is always better. Patients are followed closely with blood work, to make sure the hormone levels are dropping, which indicates the ectopic pregnancy is not continuing.
Surgery for ectopic pregnancy is either laparoscopy or laparotomy, which is used to remove the ectopic tissue and hopefully spare the fallopian tube, notes Dr. Trolice.
Doctors consider surgery if a patient has acute pain or hemorrhage, a prior or recurrent ectopic pregnancy in the tube, or the patient wants tubal sterilization which requires surgery. “Surgical management is usually laparoscopy. It can be an incision in the fallopian tube and removal of the ectopic, and then the tube is closed or allowed to heal on its own. More radically, surgery is used to remove the entire tube if it is ruptured,” Dr. Trolice explains.
“The subsequent ability to conceive is really going to be based on what the other tube looks like. If the first pregnancy a patient has is a tubal pregnancy, that is usually a poor prognosis for pregnancy inside the uterus because whatever caused the tubal pregnancy is [still] going to compromise her ability to get pregnant,” he says.
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