An ectopic pregnancy occurs when a fertilized egg implants itself outside of the uterus. They’re also called “tubal pregnancies” because most of them happen in the fallopian tubes. 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. 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. If you’re diagnosed with an ectopic pregnancy, how your doctor will treat it depends on how far the pregnancy has progressed, where the embryo is, and how severe your symptoms are. 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). Methotrexate
stops the cells from growing and allows your body to absorb the pregnancy. But the drug does have some side effects, like nausea, vomiting,
dizziness, diarrhea, and stomatitis (mouth and lip ulcers). And most women have abdominal pain a couple of days after the injection. Women used to stay in the hospital for a series of methotrexate injections. Now it’s an outpatient procedure, but your
doctor will monitor your hCG levels closely during the few weeks after to make sure they get back to zero. One injection could do the trick, but if the numbers don’t drop like they should, you might have more injections. If methotrexate therapy doesn’t work, surgery is the next step. It’s also the only option for women with high hCG levels, severe symptoms, and ruptured or damaged fallopian tubes. 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's the Treatment for Ectopic Pregnancy?
Medication
Surgery
FAQ155
Published: February 2018
Last reviewed: July 2022
Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.
This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.
Diagnosis
A pelvic exam can help your doctor identify areas of pain, tenderness, or a mass in the fallopian tube or ovary. However, your doctor can't diagnose an ectopic pregnancy by examining you. You'll need blood tests and an ultrasound.
Pregnancy test
Your doctor will order the human chorionic gonadotropin (HCG) blood test to confirm that you're pregnant. Levels of this hormone increase during pregnancy. This blood test may be repeated every few days until ultrasound testing can confirm or rule out an ectopic pregnancy — usually about five to six weeks after conception.
Ultrasound
A transvaginal ultrasound allows your doctor to see the exact location of your pregnancy. For this test, a wandlike device is placed into your vagina. It uses sound waves to create images of your uterus, ovaries and fallopian tubes, and sends the pictures to a nearby monitor.
Abdominal ultrasound, in which an ultrasound wand is moved over your belly, may be used to confirm your pregnancy or evaluate for internal bleeding.
Other blood tests
A complete blood count will be done to check for anemia or other signs of blood loss. If you're diagnosed with an ectopic pregnancy, your doctor may also order tests to check your blood type in case you need a transfusion.
Treatment
A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. Depending on your symptoms and when the ectopic pregnancy is discovered, this may be done using medication, laparoscopic surgery or abdominal surgery.
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. The medication is given by injection. It's very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment.
After the injection, your doctor will order another HCG test to determine how well treatment is working, and if you need more medication.
Laparoscopic procedures
Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. In these procedure, a small incision is made in the abdomen, near or in the navel. Next, your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the tubal area.
In a salpingostomy, the ectopic pregnancy is removed and the tube left to heal on its own. In a salpingectomy, the ectopic pregnancy and the tube are both removed.
Which procedure you have depends on the amount of bleeding and damage and whether the tube has ruptured. Also a factor is whether your other fallopian tube is normal or shows signs of prior damage.
Emergency surgery
If the ectopic pregnancy is causing heavy bleeding, you might need emergency surgery. This can be done laparoscopically or through an abdominal incision (laparotomy). In some cases, the fallopian tube can be saved. Typically, however, a ruptured tube must be removed.
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Coping and support
Losing a pregnancy is devastating, even if you've only known about it for a short time. Recognize the loss, and give yourself time to grieve. Talk about your feelings and allow yourself to experience them fully.
Rely on your partner, loved ones and friends for support. You might also seek the help of a support group, grief counselor or other mental health provider.
Many women who have an ectopic pregnancy go on to have a future, healthy pregnancy. The female body normally has two fallopian tubes. If one is damaged or removed, an egg may join with a sperm in the other tube and then travel to the uterus.
If both fallopian tubes have been injured or removed, in vitro fertilization (IVF) might still be an option. With this procedure, mature eggs are fertilized in a lab and then implanted into the uterus.
If you've had an ectopic pregnancy, your risk of having another one is increased. If you wish to try to get pregnant again, it's very important to see your doctor regularly. Early blood tests are recommended for all women who've had an ectopic pregnancy. Blood tests and ultrasound testing can alert your doctor if another ectopic pregnancy is developing.
Preparing for your appointment
Call your doctor's office if you have light vaginal bleeding or slight abdominal pain. The doctor might recommend an office visit or immediate medical care.
However, emergency medical help is needed if you develop these warning signs or symptoms of an ectopic pregnancy:
- Severe abdominal or pelvic pain accompanied by vaginal bleeding
- Extreme lightheadedness
- Fainting
Call 911 (or your local emergency number) or go to the hospital if you have the above symptoms.
What you can do
It can be helpful to jot down your questions for the doctor before your visit. Here are some questions you might want to ask your doctor:
- What kinds of tests do I need?
- What are the treatment options?
- What are my chances of having a healthy pregnancy in the future?
- How long should I wait before trying to become pregnant again?
- Will I need to follow any special precautions if I become pregnant again?
In addition to your prepared questions, don't hesitate to ask questions anytime you don't understand something. Ask a loved one or friend to come with you, if possible. Sometimes it can be difficult to remember all of the information provided, especially in an emergency situation.
What to expect from your doctor
If you don't require emergency treatment and haven't yet been diagnosed with an ectopic pregnancy, your doctor will talk to you about medical history and symptoms. You'll be asked many questions about your menstrual cycle, fertility and overall health.
Menstruation
- When was your last period?
- Did you notice anything unusual about it?
Pregnancy
- Could you be pregnant?
- Have you taken a pregnancy test? If so, was the test positive?
- Have you been pregnant before? If so, what was the outcome of each pregnancy?
- Have you ever had fertility treatments?
- Do you plan to become pregnant in the future?
Symptoms
- Are you in pain? If so, where does it hurt?
- Do you have vaginal bleeding? If so, is it more or less than your typical period?
- Are you lightheaded or dizzy?
Health history
- Have you ever had reproductive surgery, including getting your tubes tied (or a reversal)?
- Have you had a sexually transmitted infection?
- Are you being treated for any other medical conditions?
- What medications do you take?