Management of Ectopic Pregnancy

Cindy Farquhar, Martin Sowter

An ectopic pregnancy occurs when a fertilized egg implants in tissue outside the uterus – usually in the fallopian tubes. The placenta and fetus begin to develop, but there is no chance of the pregnancy continuing to full term. The developing cells must be removed; if an ectopic pregnancy proceeds, the fallopian tubes will rupture, causing internal bleeding, haemorrhage and shock. About 2% of pregnancies are ectopic, and women with a history of pelvic inflammatory disease or damaged fallopian tubes are particularly at risk.

Monitoring BHcG levels and using ultrasound now make early detection of ectopic pregnancy possible. This means medical or surgical management can be used. If the fallopian tubes are not in danger of rupturing and BHcG level are acceptable, an injection of methotrexate can be given to dissolve the fertilized egg. Alternatively, laparoscopic surgery to remove the fetus and repair damaged tissue may be required. If the fallopian tubes must be removed during surgery, 10 – 15% of women become infertile.

Professor Cindy Farquhar conducted a six-year audit of the management of ectopic pregnancy at National Women’s Hospital between 1996 and 2001, to see how practices had changed. She found that surgery was still the most frequent method of management, but methotrexate was increasingly being used. Over the six-year period only 11% of women were given methotrexate; the treatment failed for 18.9% of these women, for whom surgery was also required.

Although there is evidence that methotrexate is an effective and safe option for some women with ectopic pregnancy, the majority of women still undergo surgical management. Further research is required to assess the benefits and harms of the different treatments for ectopic pregnancy, and their long-term impact on fertility.

To go back to pregnancy complications please click here