Ectopic pregnancy is a severe medical condition when a fertilized egg implants outside the uterus, usually in the fallopian tube. This condition can be life-threatening, as it risks tubal rupture and resultant hemorrhage. In Europe and North America, ectopic pregnancy accounts for approximately 2% of all pregnancies; in the USA, it is responsible for 2.7% of pregnancy-related deaths. However, the fatality rate may be higher in low-income and middle-income countries where maternal deaths are under-reported. Black women in the USA are nearly seven times more likely to die from this condition than White women.
Ectopic pregnancy can be managed with either medical or surgical interventions for stable patients. Methotrexate injection is a standard medical treatment that can prevent the need for surgery. However, it can be a lengthy process. A retrospective study of 216 patients over 14 years showed an estimated median of 22 days for the resolution of ectopic pregnancy if medical management is successful. In some cases, patients may require a second dose of medication, and surgical intervention is still necessary in about 25% of cases.
According to The Lancet, unstable patients with ectopic pregnancy require emergency surgery to stop life-threatening bleeding. Surgical management may also result in the removal of the fallopian tube, which can impact fertility. It is essential for medical professionals to closely monitor patients with ectopic pregnancy and provide appropriate interventions to ensure the best possible outcome.
Ectopic pregnancies occur when a fertilized egg implants outside of the uterus, can be treated with methotrexate, a medication that stops cell growth and allows the body to absorb the pregnancy. While the treatment is less invasive than surgery, women may experience some side effects, such as nausea, vomiting, dizziness, diarrhea, and mouth and lip ulcers. Additionally, most women experience abdominal pain a few days after the injection. While methotrexate treatment can be outpatient, doctors closely monitor hCG levels to ensure they return to zero in the weeks after the injection. Additional injections may be necessary if hCG levels do not decrease as expected.
In cases where methotrexate therapy does not work, surgery is the next step. Women with high hCG levels, severe symptoms, and ruptured or damaged fallopian tubes must undergo surgery. Laparoscopic surgery, which involves a small cut and a tiny camera, is preferred over surgery with a more significant cut. However, emergency surgery may require a larger incision.
If the fallopian tube has ruptured or been severely damaged, it may need removal. Sometimes, the tube can be saved if the damage is minimal. After surgery, doctors monitor hCG levels to ensure they decrease correctly and that the pregnancy was removed successfully. Some women may also require a methotrexate injection to return everything to normal.