Ectopic pregnancy

My roommate was just diagnosed with an ectopic pregnancy. I always thought this was a very serious medical emergency that needed surgery, but she was treated with just a shot. Can you help clear this up? Does she really have an ectopic pregnancy?


Ectopic pregnancy is a serious medical problem that is thought to occur in about 2 percent of pregnancies. An ectopic refers to any pregnancy which implants outside of the uterine cavity. While almost all ectopics occur in the fallopian tube (98 percent), they also implant on the ovary, inside the abdominal cavity or within the cervix. Surgery is no longer the only option. Early detection makes it possible for some women to be treated with medication instead of surgery.

A history of pelvic inflammatory disease (PID), especially chlamydia, is the single most important risk factor. Smoking, history of tubal surgery or a previous ectopic, DES (diethylstilbestrol) exposure or IUD use also increase risk. Certain fertility techniques increase the risk of ectopic pregnancy such as in vitro fertilization, GIFT (gamete intra-fallopian transfer), even ovulation induction. However, most ectopic pregnancies occur in women with no apparent risk factors.

The classic warning signs of an ectopic are a late period, vaginal spotting or bleeding, and abdominal pain. In most cases not all three symptoms are present, making the diagnosis more difficult. As an ectopic pregnancy develops, it may grow large enough to tear or rupture the fallopian tube causing internal bleeding and a potentially life-threatening situation. Diagnosing an ectopic pregnancy early is key to avoiding complications. Today, 80 percent of ectopic pregnancies are treated before rupture of the fallopian tube.

The diagnosis is made using a very sensitive pregnancy test (immunoassay for human chorionic gonadotropin, or HCG), ultrasonography, and, if needed, laparoscopy. In a healthy pregnancy, HCG levels rise in a fairly predictable manner. Levels that do not rise appropriately can signal a pregnancy at risk. A progesterone blood test may also be used as an indicator of a healthy pregnancy. Ultrasound is used to locate the pregnancy or look for signs of a potential problem like swelling in a fallopian tube.

Treatment must be tailored to the individual. In some situations, emergency surgery is required to control internal bleeding. When the diagnosis is made early, prior to tubal rupture and the patient is clinically stable, treatment options include surgery or medical management what you referred to as "the shot".

Methotrexate was first used to treat an ectopic pregnancy in 1982 in Japan and has been used in the United States since 1986. But it's not for everyone. Methotrexate is given as one or two shots depending on the size of the patient and the length of pregnancy. HCG levels are followed closely to be sure the pregnancy is resolving. It takes about four weeks for HCG levels to fall to zero. Some women have side effects from the medication such as soreness in the mouth, stomach upset or diarrhea. Methotrexate can also affect liver metabolism, so women who have been treated need to avoid alcohol and folic acid. Methotrexate works about 85 percent of the time, sometimes a second injection is needed. Close follow-up is essential because treatment failures require surgery to remove the ectopic pregnancy.

Methotrexate is less expensive than surgery and since it's less traumatic to the tissues, it can be better for future fertility. While this is a reasonable option in many cases, it's not right for everyone. Some women prefer the "quick-fix" of surgery rather than the month-long process with medication. I hope you find this information helpful. It sounds as if your roommate received excellent, state-of-the-art medical care. I hope that her course proceeds smoothly.

Labels: Getting pregnant, Pregnancy health