Pregnancy After Care: Tubal ectopic pregnancy

Most women with a tubal ectopic pregnancy will need to undergo surgery in the form of laparoscopic (keyhole) surgery. At OMNI, selected women can be managed non-surgically or conservatively. This means that the woman can avoid hospital admission, general anaesthetic as well as preserve her fallopian tube. Up to one third of women are suitable for non-surgical approaches. These approaches can be either expectant or medical management.

Expectant management

As tubal ectopic pregnancies are being detected earlier and earlier through the use of advanced ultrasound technology, more women are eligible for expectant management. Expectant management means just that: a "watch and wait" approach to see if the ectopic pregnancy resolves by itself. 10 - 15% of women with a tubal ectopic pregnancy can be managed expectantly and avoid surgery.

Women who are selected for a "watch and wait" approach will be followed-up closely by the OMNI team with blood tests (pregnancy hormone levels known as hCG) and ultrasound. The levels of serum hCG need to fall to non-pregnant levels for successful expectant management to occur. Close monitoring is important as there is a small possibility that the tubal ectopic pregnancy can rupture and cause internal bleeding, despite falling hCG levels. If at any time during expectant management there are signs of this, then surgery will be arranged.

Medical management

Some women who are not eligible for expectant management can be managed medically. This is another way of avoiding surgery. This means giving the woman an injection of methotrexate. Methotrexate has been used since the 1980s as an alternative to surgery for some ectopic pregnancies. 20 - 25% of women with a tubal ectopic pregnancy can be managed medically with methotrexate.

Strict guidelines apply to the use of methotrexate. Methotrexate used in very low doses, stops the pregnancy cells from dividing, ending the pregnancy and conserving the tube where the pregnancy implants.

Methotrexate is given as a single injection into the muscle. Again, women who are selected for methotrexate therapy will be followed-up closely by the OMNI team with serum hCG levels and ultrasound. As is the case with expectant management, under rare circumstances, tubal ectopic pregnancy can rupture despite falling hCG levels. Should this be the case, surgery will be arranged.