Medication
Treatment Approaches for Tubal or Ectopic Pregnancy
- Watchful Waiting for a Tubal Pregnancy. If blood tests show that the hCG level in the blood is falling, chances are that the ectopic pregnancy is already in the process ...
- Medical Management With Methotrexate. ...
- Surgery to Repair the Tube. ...
- Trying to Get Pregnant Again After Ectopic Pregnancy. ...
Procedures
Treatment
- Medication. An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells.
- Laparoscopic procedures. Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies.
- Emergency surgery. ...
Self-care
You may be at a higher risk of developing an ectopic pregnancy if you’ve had:
- A previous ectopic pregnancy.
- A history of pelvic inflammatory disease (PID), an infection that can cause scar tissue to form in your fallopian tubes, uterus, ovaries and cervix.
- Surgery on your fallopian tubes (including tubal ligation, also referred to as having your tubes tied) or on the other organs of your pelvic area.
- A history of infertility.
How do you get rid of an ectopic pregnancy?
What Is Ectopic Pregnancy Surgery?
- Surgical Approaches. With a laparotomy, a large incision is made in the skin of the abdomen to remove the pregnancy tissue.
- Contraindications. Certain medical conditions, like underlying heart or lung disease, may increase a patient's risk for complications during surgery.
- Potential Risks. ...
How to recognize and treat an ectopic pregnancy?
What are my options after ectopic pregnancy?
What are the surgery options for an ectopic pregnancy?
What is the most common treatment for ectopic pregnancy?
The most common drug used to treat ectopic pregnancy is methotrexate. This drug stops cells from growing, which ends the pregnancy. The pregnancy then is absorbed by the body over 4–6 weeks. This does not require the removal of the fallopian tube.
Can an ectopic pregnancy be treated?
An early ectopic pregnancy may be managed with medicine. If you have low levels of hCG -- a hormone your body makes when you're pregnant and there's no damage to the fallopian tube -- your doctor can give you an injection of a drug called methotrexate (Trexall).
Can an ectopic pregnancy go away without surgery?
It is possible for an early ectopic pregnancy to end in miscarriage on its own. However, in most cases it does not, and medical intervention is needed. To treat ectopic pregnancy, the doctor will recommend either a surgical procedure or a medication called methotrexate.
How long can you go with an ectopic pregnancy?
If it's not diagnosed in time, generally between 6 and 16 weeks, the fallopian tube will rupture. This is long before a fetus could survive outside of the mother's body. The sad truth is that when a pregnancy is ectopic, the fetus will not survive.
How fast does methotrexate work for ectopic?
The average time of resolution for ectopic pregnancy was 32 days for single dose of methotrexate and 58 days for those receiving two doses or more.
Can a gynecologist treat an ectopic pregnancy?
Generally, your chances of having another ectopic pregnancy are usually around 2-3% If a fallopian tube is removed during treatment, your gynecologist can discuss your options for achieving a healthy pregnancy in the future.
Where is methotrexate injection for ectopic pregnancy?
To treat ectopic pregnancy, methotrexate is typically given as an injection (a shot) into a muscle. This often takes place in a hospital emergency room. In some cases, a second or third injection is necessary in the weeks after the first injection. Most ectopic pregnancies occur in a fallopian tube.
Can an ectopic pregnancy be seen in an ultrasound?
An ectopic pregnancy is usually diagnosed by carrying out a transvaginal ultrasound scan.
Does sperm cause ectopic pregnancy?
Based on findings in both animal and human models, we proposed the hypothesis that sperm defects may be associated with the expression of paternal genes which cause abnormal early embryo development and predispose the embryos to interact inappropriately with the genital tract epithelium, and so increase the risk of an ...
What is the main cause of ectopic pregnancy?
A tubal pregnancy — the most common type of ectopic pregnancy — happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role.
What happens after methotrexate for ectopic pregnancy?
After treatment, you may have mild abdominal pain or cramping. Some women also have nausea and vomiting, diarrhea, or fatigue. There are some cases when you can't use methotrexate.
How long does ectopic surgery take?
How long does the procedure take? It will normally take between thirty minutes to one hour, however if a laparotomy needs to be performed it may take longer. You should return to the ward one to two hours following a short time in recovery.
What to do if you have an early ectopic pregnancy?
Medication. An early ectopic pregnancy may be managed with medicine. If you have low levels of hCG -- a hormone your body makes when you’re pregnant and there’s no damage to the fallopian tube -- your doctor can give you an injection of a drug called methotrexate ( Trexall ).
Why are ectopic pregnancies called tubal pregnancies?
Whether there’s a problem with the egg or the tube, the egg gets stuck on its journey to the uterus. A pregnancy can’t survive outside of the uterus, so all ectopic pregnancies must end.
Can you save a fallopian tube?
If your tube has ruptured or been severely damaged, the surgeons might have to remove your fallopian tube. Sometimes, the tube may be saved if damage is minimal. After surgery, your doctors will watch your hCG levels to make sure they’re going down and the pregnancy was removed properly.
Can a pregnancy survive outside of the uterus?
A pregnancy can’t survive outside of the uterus, so all ectopic pregnancies must end. It used to be that about 90% of women with ectopic pregnancies had to have surgery. Today, the number of surgeries is much lower, and many more ectopic pregnancies are managed with medication that prevents them from progressing.
Can you have a laparoscopic surgery?
You may have laparoscopic surgery that involves a very small cut and a tiny camera. Surgeons prefer to use this method rather than doing surgery with a larger cut. But sometimes that’s not possible, especially if it is an emergency surgery. If your tube has ruptured or been severely damaged, the surgeons might have to remove your fallopian tube. Sometimes, the tube may be saved if damage is minimal. After surgery, your doctors will watch your hCG levels to make sure they’re going down and the pregnancy was removed properly. Some women also need a methotrexate injection so everything returns to normal.
What is the purpose of ectopic pregnancy?
The current reasoning requires that in administering an operation, treatment, or medication, it must have the direct purpose of alleviating a serious pathological condition in the mother. However, in the case of ectopic pregnancy, that pathological condition is the disordered physical union between the mother and her fetus. It is the continuation of the disordered union that gravely threatens the life of the mother. The separation of the mother from her embryo or fetus is indeed “the means by which” the pathology is actuallyaddressed. The death of the fetus is an indirect result of the separation.
What is the ethical framework for clinical decision making in the case of ectopic pregnancies?
Focusing on the disordered union of mother and unborn child clarifies the object and purpose of the actions used to separate the mother and fetus in order to save the life of both, or at least one. Since over 90% of tubal ectopic pregnancies present as embryos who have already died, these cases present no ethical dilemma. This paper proposes a modification of currently used criteria for determining the viability of ectopic pregnancies and calls for further research.
What is direct abortion?
The difficulty with this definition of “direct abortion” is that it is not a medical definition, and operationally does not distinguish between the separation of the mother and the fetus in order to kill the fetus, and the separation of the mother and the fetus in order to save the mother’s life. Importantly, as defined by the USCCB, if direct abortion requires the “sole immediate effect” to be the termination of pregnancy, then inherent in the term “direct” is the assumption that any separation is by definition designed with the primary intent of killing the fetus. Thus, the definition itself implicitly assumes the malice that it condemns.
Why is the uterus not removed?
However, it is important to note that in this situation, the uterus is not removed because it is “malfunctioning.” Indeed, given that the primary function of the uterus is to gestate a fetus, a malfunctioninguterus would result in spontaneous miscarriage. Rather, the uterus is removed because it harbors cancerous cells. Cancer ultimately proves fatal only when the physical growth or biochemical products of the cancerous tumor compromise a vital organ or vital physiologic process. Removal of a cancerous uterus prevents the spread of these potentially fatal cells to new locations in the body. Thus, based on the position of the USCCB, removal of an otherwise functionaluterus that harbors both a living fetus and cancerous cells is warranted to protect the life of the mother. However, in the face of chemotherapy agents and radiation therapy that have proven successful in the treatment of gynecological cancers in pregnant women without harming the fetus, this reasoning is further weakened (Amant et al. 2015).
Can a fallopian tube cause ectopic pregnancy?
It is also not necessarily true that permanent pathology in the fallopian tube itself induced the disordered union. While known risk factors for ectopic pregnancy include previous tubal damage from infection or scarring, there are other temporary and transient risk factors that cause ectopic pregnancy, including the use of Intra Uterine Devices (IUDs) and progestins in hormonal contraceptives (Li et al. 2015).
Is there a viable fetus in ectopic pregnancy?
In particular, it is not widely appreciated that by the time an ectopic pregnancy is diagnosed, in most cases, there is no viable fetus (i.e., the fetus has already died). Moreover, there is very little ethical guidance from the medical profession regarding the emotionally difficult decision to terminate a wanted pregnancy when the life of the mother is at risk. The best articulated positions on this topic come from religious groups, based on the principle of double effect. Yet the application of this reasoning to termination of an ectopic pregnancy is inconsistent with the medical facts in many cases. To resolve these inconsistencies, while still providing a robust ethical context for resolving such difficult situations, we propose clear guidelines for determining when a viable fetus is present in ectopic pregnancy and clarify the moral object in ectopic pregnancy management.
Can progesterone remove fallopian tubes?
The fact that a normal fallopian tube can be altered by progestins to allow for ectopic implantation presents a problem for the ethical analysis which states that a diseased state must exist in the organ, necessitating surgical removal of the organ, despite the fetus dying as the unintentional “double effect.” In the case of progesterone contraceptive use, the tube is not abnormal, and to remove the tube or portion of the tube in order to treat the ectopic pregnancy results in the added effect of permanently decreasing or eliminating the woman’s future fertility. In cases of abdominal pregnancies, or ovarian pregnancies, control of hemorrhage may or may not require removal of the organ on which the fetus implanted, and most frequently, the fetus is removed and the placenta left to resorb on its own (Ayinde et al. 2005; Huang et al. 2014). The idea of removing normally functioning organs because they harbor an implantation site of an ectopic pregnancy does not make those organs “diseased,” calling into question the basis of the current ethical framework.
Why is it important to treat an ectopic pregnancy?
Quick treatment for an ectopic pregnancy is important to protect the mother’s life. If the egg has implanted in the fallopian tube and the tube bursts, there can be severe internal bleeding. This can lead to maternal death.
What causes an ectopic pregnancy?
In most cases, an ectopic pregnancy is caused by conditions that slow down or block the movement of the egg down the fallopian tube and into the uterus.
How do you know if you are pregnant with an ectopic pregnancy?
However, you may experience additional symptoms during an ectopic pregnancy, including: Vaginal bleeding. Pain in your lower abdomen, pelvis and lower back. Dizziness or weakness.
Where does the egg go in pregnancy?
The egg is meant to travel down the fallopian tubes and imbed itself into the wall of your uterus, where it can begin to develop. In an ectopic pregnancy, the egg implants in one of the structures along the way. The most common place this can happen is within the fallopian tubes.
Where does ectopic pregnancy occur?
An ectopic pregnancy often happens in the fallopian tube (a pair of structures that connect the ovaries and uterus). In rare cases, an ectopic pregnancy can occur on an ovary or in the abdominal cavity. This is a life-threatening condition. An ectopic pregnancy is not a pregnancy that can be carried to term ...
What is the test called for a pregnant woman?
You may also hear this called your serum beta-hCG level. An ultrasound exam: An imaging test, an ultrasound uses sound waves to create a picture of your body’s internal structures. Ultrasound is often used during pregnancy. Your provider will use this test to see where the fertilized egg has implanted.
Can an ectopic pregnancy be fatal?
Unfortunately, an ectopic pregnancy is fatal for the fetus . It cannot survive outside of the uterus. Quick treatment for an ectopic pregnancy is important to protect the mother’s life. If the egg has implanted in the fallopian tube and the tube bursts, there can be severe internal bleeding.
How to treat ectopic pregnancy?
If an ectopic pregnancy is diagnosed early but active monitoring isn't suitable, treatment with a medicine called methotrexate may be recommended. This works by stopping the pregnancy from growing. It's given as a single injection into your buttocks. You won't need to stay in hospital after treatment, but regular blood tests will be carried out ...
What is the procedure to remove a pregnancy?
In most cases, keyhole surgery (laparoscopy) will be carried out to remove the pregnancy before it becomes 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.
What is the procedure to stop bleeding in the fallopian tube?
The surgeon will make a larger incision in your tummy (laparotomy) to stop the bleeding and repair your fallopian tube, if that's possible. After either type of surgery, a treatment called anti-D rhesus prophylaxis will be given if your blood type is RhD negative (see blood groups for more information).
What is the treatment for expectant management?
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.
What to do if your hormone levels don't go down?
You may need further treatment if your 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 stops. You may experience some tummy pain – take paracetamol to relieve this.
What is the name of the medication that stops pregnancy growth?
medication – a medicine called methotrexate is used to stop the pregnancy growing
How long does it take to recover from a fallopian tube?
Most women can leave hospital a few days after surgery, although it can take 4 to 6 weeks to fully recover. If your fallopian tube has already ruptured, you'll need emergency surgery.
What is the procedure for ectopic pregnancy?
During ectopic pregnancy surgery, the surgeon will perform one of these procedures: Salpingectomy: Pregnancy tissue is removed along with part or all of the fallopian tube. Salpingostomy: Pregnancy tissue is removed and fallopian tube is repaired. The decision depends on a number of factors, including the condition of the tube, ...
What Is Ectopic Pregnancy Surgery?
Ectopic pregnancy surgery is performed under general anesthesia by an obstetrician-gynecologist (OB/GYN). The surgery is usually scheduled but may be performed due to an emergency.
What is the procedure to remove a fallopian tube?
Salpingectomy: The fallopian tube containing the ectopic pregnancy will be partially or totally removed using various surgical instruments (e.g., clamps, grasping forceps, scissors, and/or a device that releases heat). Salpingostomy: Alternatively, an incision will be made within the tube overlying the ectopic pregnancy.
How long does it take to recover from a laparoscopic ectopic pregnancy?
A laparotomy, on the other hand, requires a two to six-week recovery period. 12. As you recover, you can expect the following: 10. Abdominal soreness and swelling are common after surgery.
What is the hormone used to diagnose ectopic pregnancy?
An ectopic pregnancy is diagnosed with a transvaginal ultrasound and a blood measurement of the pregnancy hormone, human chorionic gonadotropin (hCG) .
How long does it take to get an ectopic pregnancy?
This tube is connected to a ventilator that takes control of your breathing during the operation. Ectopic pregnancy surgery takes around 45 to 90 minutes to complete and generally proceeds in the following fashion: 2. Incision: The surgeon will make one or more incisions over the abdomen.
Where do ectopic pregnancies occur?
In the vast majority of cases, ectopic pregnancies occur within one of the fallopian tubes. These narrow tubes connect a woman's ovaries to her uterus. Less commonly, a fertilized egg may begin developing within a woman's cervix, ovary, abdomen, or prior cesarean scar. 1.
How to diagnose extrauterine pregnancy?
75% of tubal pregnancies can be detected by transvaginal ultrasonography. In patients with a vital extrauterine pregnancy, the human chorionic gonadotropin concentration generally doubles within 48 hours. Laparoscopy is the gold standard of treatment. Two randomized, controlled trials comparing organ-preserving treatment with ablative surgery revealed no significant difference in pregnancy rates after the intervention, but precise details of the surgical procedures were not provided, and long-term fertility data are lacking. Methotrexate therapy should be used only for strict indications.
What is the difference between tubal and extrauterine pregnancy?
Extrauterine (ectopic) pregnancy is the implantation of a fertilized oocyte outside the uterine cavity. Tubal pregnancy (Figure 1) is only one kind of extrauterine pregnancy, albeit the most clinically significant; non-tubal and heterotopic extrauterine pregnancies are rare (1–3%) (1).
How much of maternal mortality is caused by extrauterine pregnancy?
Extrauterine pregnancy is a complication of the first trimester of pregnancy that carries major morbidity and mortality. Even today, it accounts for as much as 6% of pregnancy-associated mortality (1, 2). Improved diagnostic and therapeutic methods have made maternal death from extrauterine pregnancy rare as a global phenomenon (0.05%), yet the quality of diagnosis and treatment of this condition is not uniform (2, 3). Despite the availability of minimally invasive surgical methods, delayed diagnoses and errors in acute treatment and follow-up care still make ruptured extrauterine pregnancy a part of everyday life in obstetrics and gynecology.
Is tubal pregnancy a risk factor?
Prior tubal surgery or a prior tubal pregnancy are the most important risk factors for tubal pregnancy (6, 7) (Table 1). Sterilization is a very effective method of contraception; nevertheless, if a woman becomes pregnant despite having undergone a putatively sterilizing procedure, extrauterine pregnancy must be considered as a possibility, as about 30% of pregnancies after sterilization are extrauterine (8). The cumulative 15-year risk of tubal pregnancy is 2.9 per 1000 sterilizations (9). The risk of tubal pregnancy is higher after electrocoagulation of the fallopian tubes, because of tubal recanalization and/or the formation of a utero-/tuboperitoneal fistula (8).
Is extrauterine pregnancy multifactorial?
Extrauterine pregnancy is of multifactorial origin. Up to half of all women with an extrauterine pregnancy have no recognized risk factors for it (5). The postulated mechanisms include anatomical and/or functional tubal obstruction, impaired tubular motility and ciliary dysfunction, and molecular chemotactic factors that stimulate and promote tubal implantation (5).
Can Chlamydia trachomatisor cause pregnancy?
Women with an active or prior ascending infection with Chlamydia trachomatisor Neisseria gonorrhoeaeare at an elevated risk of extrauterine pregnancy. Other types of intra-abdominal infection, e.g., appendicitis, can also raise the risk (13).
Does Clomifene cause extrauterine pregnancy?
Elevated rates of extrauterine pregnancy have been found among women taking hormones (clomifene) to treat infertility, although the increased prevalence of tubal pathology and prior surgical treatments in this population are obvious confounding variables (1). Assisted reproductive technology (ART) has also been reported to elevate the risk of an extrauterine pregnancy from 0.025% (the value in the general population) to 1% among women who have undergone in vitro fertilization (11). The incidence of extrauterine pregnancy after ART seems to have fallen somewhat in recent years (12).
What are the risks of ectopic pregnancy?
Bearing in mind that about 50 percent of ectopic pregnancies occur in patients who have no known risk factors, risk factors that increase the risk of ectopic pregnancy are those that affect the free passage of the fertilized egg from getting into the uterine cavity. This may include: 1 Scarred or interrupted fallopian tube, whether due to prior surgery or infection (most commonly chlamydia) 2 Pregnancies that are a product of infertility treatment 3 A prior ectopic pregnancy
How much risk of recurrence of pregnancy?
There is a 10 percent risk of recurrence, which is why it’s important to work with your provider when planning for a future pregnancy. Also, early documentation of an intrauterine gestational sac is of paramount importance.
Can a fallopian tube be removed?
If the fallopian tube is significantly damaged, it might need to be removed. The condition of the fallopian tube and degree of damage by the ectopic pregnancy usually determines the recommended approach.
Can an ectopic pregnancy coexist with another pregnancy?
It’s rare for an ectopic pregnancy to coexist with another normal intrauterine pregnancy, yet it’s still possible and poses critical challenges in diagnosis and treatment. Luckily, it’s an uncommon event, except in patients receiving fertility treatments, where the prevalence is a ratio of one in 100, as compared to one in 30,000 in spontaneous ...
Does fallopian tube surgery affect fertility?
Studies that have looked at the difference in fertility after treatment of ectopic pregnancy showed that medical treatment of early ectopic pregnancies with medication, compared to fallopian-tube-sparing surgical treatment, had no adverse fertility outcome.
Can ectopic pregnancy be seen on ultrasound?
Sometimes, diagnosis can be challenging if the ectopic pregnancy is in its early stage and the sac is not yet visible by ultrasound. In these scenarios, pregnancy hormone levels are monitored for the rate of rise, which tends to be abnormal in cases of pregnancy in ectopic implantations.
Can ectopic pregnancy be missed?
Unfortunately, an ectopic pregnancy doesn’t have specific symptoms and can be easily missed if the health care provider fails to keep it in mind. Ectopic-pregnancy-related symptoms do vary between showing no symptoms at all, especially during the very early stages, to severe lower abdominal pain with dizziness caused by massive internal bleeding.
What is the best way to manage ectopic pregnancy?
Conservative/observation management . The wait and watch approach is a safe and appropriate way to manage ectopic pregnancy . Managing the condition without treatment can feel quite scary, but it is good to give the body the best chance to resolve naturally.
How is ectopic pregnancy managed?
Ectopic pregnancy is managed differently depending on the severity. Ectopic pregnancy is usually managed through medications, surgery or observation . The type of management depends on the severity of the condition.
What is an ectopic pregnancy?
Ectopic pregnancy is the medical condition in which the implantation of an embryo occurs outside of the uterine cavity (the womb), most commonly in the fallopian tube. Hence, an ectopic pregnancy is also called a tubal pregnancy. It is a potentially serious condition affecting at least one in 1,000 pregnancies. Sadly, there is no possibility that pregnancy can survive. Below are a few risk factors
How long does it take to get ectopic pregnancy surgery?
If the physician prefers laparoscopic surgery, it will take about 30 minutes to 1 hour. However, if the physician chooses laparotomy, it might take longer to complete.
How does methotrexate help with ectopic pregnancy?
Methotrexate is a chemotherapy drug that stops the pregnancy from growing . It is the medical treatment used to dissolve the ectopic pregnancy. If the ectopic pregnancy is small and the pregnancy hormone levels are not high, there is a 90% to 95% chance that using medical treatment would be safe. Methotrexate is given by a single injection in the arm. In certain situations, an infusion via a drip into the vein may be required. Pregnancy hormone levels would be monitored simultaneously. Side effects are temporary, which include abdominal pain, nausea, vomiting, indigestion, mouth ulcers, sensitivity to light or feelings of fatigue. Very rarely it can affect the liver or blood counts.
How many chances are there that an ectopic pregnancy will resolve itself?
If a doctor suggested this method of treatment, then there is an almost 90% chance that the ectopic pregnancy will resolve all by itself. The patient would be observed closely until ectopic pregnancy is absorbed and there are minimal or no symptoms (like pain or bleeding).
What is the purpose of a laparoscope in a belly button?
A thin, flexible instrument with a camera and light source on its end (laparoscope) is inserted through the incision in the belly button to allow the surgeon to see what they are doing. If an ectopic pregnancy is confirmed, the tube is usually removed.