As with any pregnancy there are 3 possibilities of how an ectopic pregnancy progresses.
Some ectopic pregnancies will continue to grow whilst others will fail. In those that fail some will “fall” out of the fallopian tube resulting in a tubal miscarriage. Or the ectopic the pregnancy “realizes” that it is not in the "right" place and a miscarriage happens within the tube. In this scenario the pregnancy resorbs itself over time.
The modern management of ectopic pregancy is based on these possibilities.
Once an ectopic pregnancy is diagnosed further management depends on
- The symptoms of the ectopic pregnancy
- Findings on ultrasound
- Findings of the blood tests bHCG, and progesterone.
Based on the above principles ectopic pregnancies are either managed:
- Conservatively
- Medically
- Surgically.
Surgical management
Surgical management is the commonest method of management and is used in women with ectopic pregnancy in fact in modern units about 70% of ectopic pregnancies are managed surgically
In women with symptoms with ultrasound findings of a “live” pregnancy in the tube with the fetal heart beating will be advised to have surgical management of their ectopic pregnancies as they are unlikely to resorb spontaneously
In women with symptoms who have ultrasound findings suggestive of rupture of the pregnancy and bleeding within the abdomen will also be advised to have surgical management
Conservative management
this method is based on the principle that some ectopic pregnancies will absorb themselves. It have the advantage of avoiding surgery but the disadvantage that complete resolution of the pregnancy may take time.
it is be used In selected Women who have minimal symptoms and the
- Pregnancy hormone levels are low usually less than 1000IU with low progesterone levels
- With an ectopic mass with no heart beat
- With the mass less than <3cm
- With no evidence of internal bleeding
it can also be used in women who have been under surveillance for ectopic pregnancy where the location of the pregnancy remains uncertain and if the pregnancy hormone levels are also found to be falling.
Such women are usually followed up in an early pregnancy assessment unit till the pregnancy mass completely resorbs and until the pregnancy hormone levels are no longer detectable in urine samples.
Women are advised to refrain from intercourse and if symptoms worsen they are advised to return to the early pregnancy unit.
Medical management
Selected Women who have minimal symptoms with hormone levels between 1000-3000IU may be offered medical management
The commonest method is administration of a drug called methotrexate. This is a drug that destroys rapidly dividing cells; it is used to treat certain cancers.
The objective is for the drug to help in the resorption of the pregnancy.