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THE MEDICAL TREATMENT OF ECTOPIC (TUBAL) PREGNANCY

An ectopic pregnancy (EP) is a pregnancy abnormally located in the fallopian tube (not in the normal location within the uterus). An EP requires treatment as there is a high risk that the pregnancy will grow and the fallopian tube will rupture causing severe internal bleeding (with the risk of hemorrhagic shock, even death). An EP cannot result in the birth of a live baby.

Diagnosis is made by blood pregnancy tests called quantitative BHCG and sonograms and pelvic exams.  If you think you are pregnant and have severe abdominal or pelvic pain, you should go to the emergency room or speak to your doctor.
Risk factors for ectopic include such things as: history of pelvic infection, including chlamydia or gonorrhea, previous tubal or ovarian surgery or any pelvic surgery (leads to scarring of the tubes), IUD, previous ectopic or infertility, previous tubal ligation, or other contraception which has failed.
Early miscarriages or blighted ovum can appear with the same symptoms.  Often there is some vaginal bleeding and cramping associated.
Surgical Treatment
To date, the treatment of an EP has required hospitalization of the patient and surgery with anesthesia to remove the pregnancy (sometimes it is necessary to also remove the fallopian tube).

Medical Treatment
Recently, an alternative medical treatment has been proposed to manage an EP. This treatment is an injection of the drug Methotrexate (MTX) that will destroy the growing placental tissue and end the EP. If this is successful, it will avoid the need for hospitalization and surgery. Recovery will be more rapid. Also, there are indications that medical treatment could cause less damage to the fallopian tube than surgery. This is an important consideration if future pregnancies are desired.
To have medical treatment requires the following conditions:
  1. Additional blood tests (blood count, quantitative pregnancy test, liver, and kidney function tests).
  2. Repeat blood tests and office visits 4, 7 and 14 days after the MTX injection.
  3. Sonograms possibly every week for 1-4 weeks.
The patient must agree not to travel out of the indicated area for a minimum of 4 weeks following the injection. Also, the patient must abstain from sex for 4 weeks. The patient may experience an increase in abdominal pain 3-4 days after the injection.
Patients must abstain from any alcohol, including beer, and avoid taking any vitamins for at least 4 weeks following the injection.
Although no serious side effects are expected, possible side effects of MTX include a decrease in the white blood cell count, nausea, and changes in liver enzyme functions. None of these changes are permanent.
It may be necessary to receive a second injection of MTX 7 days after the first. This depends on the patient's course and lab results.
It is possible that medical treatment will not succeed in which case the patient would require hospitalization and surgery. This could be on an emergent or "urgent" basis.
Patients should avoid another pregnancy (that is, use contraception) for a minimum of 2 months after treatment for EP.
 




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