Your doctor has diagnosed you with an ectopic pregnancy. We understand that this can be highly distressing for you.
Your consultant has reviewed the results of your blood tests and scan. They suggest that that your ectopic pregnancy is suitable for treatment with medicine. (We call this medical management).
About medical management
Medical management of an ectopic pregnancy means treating it using a drug called methotrexate.
Methotrexate interferes with cell growth, and so stops the pregnancy from developing any further.
Your body can then gradually reabsorb the ectopic pregnancy. This leaves your fallopian tube intact.
About methotrexate
The manufacturer’s license for this drug does not specifically cover its use for ectopic pregnancy. However, studies show that methotrexate is safe and effective when used for ectopic pregnancy. They also show it is safe and effective as an additional treatment (after surgery) to retain the fallopian tube.
Methotrexate is most effective in the earlier stages of pregnancy. This is usually when your levels of bHCG (pregnancy hormone) are low.
If you have an ectopic pregnancy, your levels of bHCG, rather than your stage of pregnancy, are an important marker for us. Your levels of bHCG help us determine the best treatment for you.
Effectiveness
Methotrexate is effective in 90 to 90% of cases, but this depends on your bHCG levels.
Most women only require a single dose, but sometimes they need a second dose.
After taking the drug, you will need weekly blood tests to check your bHCG levels. This will make sure the drug treatment has been effective.
During treatment
To treat an ectopic pregnancy using medicine, we inject the drug into your bottom, arm or leg muscle. We calculate the dose according to your height and weight.
Before you have the injection, we will test your blood to make sure your liver and kidney function are normal and you are not anaemic. If you are anaemic it means your blood has a low number of red blood cells or haemoglobin (which transports oxygen in your blood).
Blood tests afterwards
Treatment with methotrexate means you avoid undergoing surgery to manage your ectopic pregnancy. However, this treatment needs careful monitoring and follow-up. You will have to attend the hospital for regular blood tests to monitor your bHCG levels after having the injection. This can take several weeks.
We will test your bHCG levels on the day we give you the injection, and on days 4 and 7 afterwards. We will telephone you with the results of your blood tests.
Be aware that bHCG levels often rise on day 4 after the injection. This is because methotrexate takes time to work properly. For most women, their bHCG levels will reduce by at least 15% on day 7.
If this does not happen, your consultant may recommend a second dose of methotrexate. We will then continue to measure your bHCG levels weekly, until they drop to <10 IU/L (ie confirmed no pregnancy present).
Side effects
It is common to experience some lower abdominal pain after a few days as the treatment starts to work.
Some women experience nausea and vomiting, diarrhoea, a sore mouth, indigestion, vaginal bleeding or tiredness.
After treatment
Follow this guidance until your bHCG levels drop to <10 IU/L (ie confirmed no pregnancy present).
- Do not use aspirin or ibuprofen for 1 week after treatment. You can take paracetamol.
- Always attend your follow-up blood tests, until we confirm your treatment is complete.
- Use effective contraception for at least 3 months after treatment. If you become pregnant during the first 3 months, this can harm your baby.
- Avoid sexual intercourse until we confirm that your treatment is complete.
- Avoid alcohol and vitamin preparations containing folic acid.
- Avoid direct sunlight.
- Avoid heavy exercise.
When to seek urgent medical help
Go to your nearest Emergency Department (A&E) if:
- you experience sudden, severe pain, or dizziness or fainting
- you are bleeding heavily (flooding sanitary pads every 20 to 30 minutes).
Emotional recovery
For many women, having treatment for an ectopic pregnancy is physically stressful and emotionally upsetting. This is normal.
You may still 'feel' pregnant until your bHCG levels go down. This can take several weeks. Once your pregnancy hormone levels fall and we confirm that your pregnancy has ended, it is not unusual to feel sad and depressed.
We advise you to give yourself time to recover.
Anyone can experience an ectopic pregnancy. Unfortunately, there is nothing you could have done to avoid it.
Future pregnancy
We recommend you wait at least 3 months before you try for a baby again. This will allow your body to resume its normal cycle.
If you have had one ectopic pregnancy, you are at risk of having another. For this reason, we will monitor your next pregnancy from an early stage.
Get in touch with Jasmine Unit as soon as you have a positive result for a pregnancy test. We will arrange for you to have an ultrasound scan at around 5 weeks.
Contact information
Kingston Hospital Jasmine Unit (6th floor, Esher Wing)
Monday to Friday, 9am to 5pm
If you need help out of hours, call NHS 111 or go to your nearest Emergency Department (A&E).
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