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All your pregnancy questions answered

Previous:Ectopic pregnancy

How is an ectopic pregnancy treated?

An ectopic pregnancy could be treated with a variety of methods depending on

• how early it is diagnosed

• whether it has ruptured or not

• where it is located

• how large it is

The biggest risk of an ectopic pregnancy is that as it grows it may rupture and that is disastrous and life threatening. It used to be one of the common OBGYN emergencies but a ruptured ectopic is less often seen nowadays as it is often diagnosed in the earlier stages itself.

1. Conservative management

If the ectopic is very early and the HCG levels low, one can choose to simply wait and watch. Often, the HCG levels will fall, meaning that the pregnancy is being reabsorbed by the body on its own and no treatment is needed. You would however need to keep a watch on the patient maybe on a daily basis and follow up the blood HCG levels every 48 hours till it falls to a level below 10

2. Medical management

This involves the use of the anti-cancer drug, methotrexate, which acts on the rapidly dividing cells of the tubal pregnancy and kills them, thus preventing the pregnancy from growing further. After giving an intramuscular injection of methotrexate, the beta HCG levels need to be monitored regularly, to ensure they are falling, till they decline to zero. This confirms that the pregnancy has been successfully destroyed.

3. Surgical management

Surgical treatment could be carried out by both the laparoscopic [keyhole surgery] route or the traditional open surgery. Whatever the route the two most common surgical treatments are

• Salpingostomy-the tube is cut open and the pregnancy tissue removed. The tube is thereby saved and helps for further fertility. This is not usually done if the tube looks badly damaged or has already ruptured

• Salpingectomy-where the entire fallopian tube is removed. This will not hamper fertility if the other tube is normal and functional.

The current "gold standard" for the treatment of an ectopic pregnancy [even a ruptured one - unless the patient has had a very large amount of internal bleeding], is laparoscopic surgery. Open [conventional] surgery should only very rarely be required for ectopic pregnancies in the modern day.

When would the tube need to be removed?

Your surgeon would remove the affected tube for any the following reasons:

• the tube has already ruptured

• the ectopic pregnancy is large and the tube has been significantly damaged

• the ectopic pregnancy is in the "isthmic" region. This is the narrow portion of the tube that is closer to the uterus. Here an ectopic which is small also would have likely damaged the tube and if you save the unhealthy tube the patient often has a repeat ectopic pregnancy at the same site at a later date

• if after a salpingostomy, where the tube is cut open and the pregnancy tissue removed, the bleeding from the tube does not stop

• if you no longer desire a child [the affected tube would be removed and a band would be placed on the other tube]

What after an ectopic pregnancy?

What about the chances of getting pregnant after an ectopic pregnancy? Because tubal disease usually damages both sides, the chances of being infertile are increased. Also, the risk of a repeat ectopic pregnancy are increased even if the other tube seems normal.

However, about 60% of women who have had a tubal pregnancy the first time will have a normal pregnancy the next time without further treatment. Early testing during pregnancy to rule out a repeat ectopic is essential!

If pregnancy does not occur within about a year of trying, then treatment is needed. Treatment options for fertility will depend upon what surgery was done for the ectopic pregnancy; and what the condition of the other tube is. Often, a second look laparoscopy is needed, to assess tubal status. Options may include: ovulation induction; tubal surgery; laparoscopic surgery; and often IVF.

Having had an unsuccessful outcome the first time makes getting pregnant very stressful - especially if the tubal pregnancy ended in a rupture. However, with the right treatment, chances of having a baby are quite good - after all, the fact an ectopic pregnancy occurred means that the eggs and sperms are good!