Materiały źródłowe

• #1 Ectopic pregnancy – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088

  An ectopic pregnancy can’t proceed normally. The fertilized egg can’t survive, and the growing tissue may cause life-threatening bleeding, if left untreated. […] An ectopic pregnancy can cause your fallopian tube to burst open. Without treatment, the ruptured tube can lead to life-threatening bleeding. […] There’s no way to prevent an ectopic pregnancy, but here are some ways to decrease your risk: Limiting the number of sexual partners and using a condom during sex helps to prevent sexually transmitted infections and may reduce the risk of pelvic inflammatory disease. […] A tubal pregnancy the most common type of ectopic pregnancy happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role.

• #2 Understanding Ectopic Pregnancy | ACOG

  https://www.acog.org/advocacy/facts-are-important/understanding-ectopic-pregnancy

  Treatment for ectopic pregnancy requires ending a nonviable pregnancy. This treatment exists within the spectrum of lifesaving care during pregnancy, including induced abortion that also ends a pregnancy. While the indication and treatment for ectopic pregnancies is distinct from the indication and provision of induced abortion, they are both essential, critical aspects of health care. […] Patients with an ectopic pregnancy must have timely access to all treatment options. […] An untreated ectopic pregnancy is life threatening; withholding or delaying treatment can lead to death. […] Legislation that bans abortion care for those with an ectopic pregnancy or mandates how clinicians treat ectopic pregnancies does not reflect the clinical reality of ectopic pregnancy management and could result in delays or even denials of care. […] Any application of an abortion ban that affects those in need of treatment for ectopic pregnancy is inappropriate and will certainly cost lives.

• #3 70 Basic icons by Xicons.co

  https://ectopic.org.uk/treating-an-ectopic-pregnancy

  There are three main ways of treating an ectopic pregnancy: expectant management (watchful waiting to see if the pregnancy resolves on its own); medical management with a drug called methotrexate; and surgery. […] Surgical management is the most established form of treatment and means performing an operation to remove the ectopic pregnancy while you are under general anaesthetic. […] The term medical management, when used in relation to ectopic pregnancy, means using a drug called methotrexate. The drug stops the pregnancy developing any further and it is gradually reabsorbed by the body, leaving the Fallopian tube intact. […] The term expectant management is usually defined as watchful waiting or close monitoring by medical professionals instead of immediate treatment. […] Research has shown that, in pregnant women with an ectopic pregnancy who are properly assessed and their pregnancy hormone level (beta hCG) is dropping, up to 50% of these pregnancies will end naturally and there will be no need for an operation or a drug to treat the condition. […] Doctors always consider the least invasive form of treatment or management first where they can. […] An ectopic pregnancy can be life-threatening for a woman or pregnant person and so must be diagnosed and treated quickly.

• #4 Diagnosis and management of ectopic pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3213855/

  Ectopic pregnancy is one of the few medical conditions that can be managed expectantly, medically or surgically. […] Ectopic pregnancy may be managed surgically, medically or expectantly. […] Surgical management is imperative in the clinical scenario of a ruptured ectopic pregnancy. A laparoscopic approach is preferable to an open approach in a patient who is haemodynamically stable. […] Medical treatment is useful for patients with an unruptured tubal ectopic pregnancy who are haemodynamically stable and have minimal symptoms and a low volume of free intraperitoneal fluid on ultrasound scan. […] Medical management with methotrexate is successful for small, stable ectopic pregnancies. […] Some ectopic pregnancies resolve spontaneously through either regression or tubal abortion, without causing harm to the patient. Expectant management is a conservative strategy consisting of observation and assessment of whether the ectopic pregnancy is continuing to resolve spontaneously and successfully without intervention.

• #5

  https://www2.hse.ie/conditions/ectopic-pregnancy/treatment/

  An obstetrician (pregnancy doctor) will advise you on the most suitable treatment for your ectopic pregnancy. […] Treatment options might include: medical treatment, surgical treatment, expectant management. […] Medical treatment is the injection of a drug called methotrexate. This prevents the ectopic pregnancy from growing. […] The main advantage of having methotrexate treatment is that you do not need to have surgery or take a general anaesthetic. […] Surgical treatment will treat the ectopic pregnancy more quickly than medical treatment. […] This is normally a laparoscopy, which is a type of keyhole surgery. A small cut is made in your tummy and the ectopic pregnancy is removed. […] There’s a good chance the pregnancy will dissolve by itself if you have no symptoms or mild symptoms. […] In this case, you may only need to be closely monitored. […] After you’ve been diagnosed with an ectopic pregnancy, your doctor should discuss your treatment options with you. This will help you to make an informed decision.

• #6 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #7 Diagnosis and management of ectopic pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3213855/

  Ectopic pregnancy is one of the few medical conditions that can be managed expectantly, medically or surgically. […] Ectopic pregnancy may be managed surgically, medically or expectantly. […] Surgical management is imperative in the clinical scenario of a ruptured ectopic pregnancy. A laparoscopic approach is preferable to an open approach in a patient who is haemodynamically stable. […] Medical treatment is useful for patients with an unruptured tubal ectopic pregnancy who are haemodynamically stable and have minimal symptoms and a low volume of free intraperitoneal fluid on ultrasound scan. […] Medical management with methotrexate is successful for small, stable ectopic pregnancies. […] Some ectopic pregnancies resolve spontaneously through either regression or tubal abortion, without causing harm to the patient. Expectant management is a conservative strategy consisting of observation and assessment of whether the ectopic pregnancy is continuing to resolve spontaneously and successfully without intervention.

• #8 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #9 Diagnosis and treatment of ectopic pregnancy | British Columbia Medical Journal

  https://bcmj.org/articles/diagnosis-and-treatment-ectopic-pregnancy

  Early diagnosis of ectopic pregnancy is critical to reducing maternal mortality and improving treatment success rates, especially since many women have no identifiable risk factors. […] Expectant management of ectopic pregnancy involves allowing the pregnancy to take its natural course with close physician follow-up until there is clinical resolution of symptoms, a negative urine pregnancy test, or negative serum b-hCG. There is evidence that expectant management of ectopic pregnancy can be a safe option in a select population of women who are hemodynamically stable, asymptomatic, have a b-hCG value less than 1000 IU/L, with decreasing levels, and can reliably access regular physician follow-up. […] Methotrexate, the most common option for treating ectopic pregnancy, was first used for this purpose in 1982. It is a folate antagonist that prevents DNA replication and affects rapidly proliferating cells like that of a developing embryo. A single dose of methotrexate is administered intramuscularly based on body surface area (50 mg/m2). Its effectiveness is assessed by serial b-hCG measurements on days 4 and 7 post-treatment, then weekly until resolution. A reduction of less than 15% in b-hCG level between days 4 and 7 posttreatment may indicate that treatment is inadequate; therefore, a second dose of methotrexate might be required.

• #10 70 Basic icons by Xicons.co

  https://ectopic.org.uk/treating-an-ectopic-pregnancy

  There are three main ways of treating an ectopic pregnancy: expectant management (watchful waiting to see if the pregnancy resolves on its own); medical management with a drug called methotrexate; and surgery. […] Surgical management is the most established form of treatment and means performing an operation to remove the ectopic pregnancy while you are under general anaesthetic. […] The term medical management, when used in relation to ectopic pregnancy, means using a drug called methotrexate. The drug stops the pregnancy developing any further and it is gradually reabsorbed by the body, leaving the Fallopian tube intact. […] The term expectant management is usually defined as watchful waiting or close monitoring by medical professionals instead of immediate treatment. […] Research has shown that, in pregnant women with an ectopic pregnancy who are properly assessed and their pregnancy hormone level (beta hCG) is dropping, up to 50% of these pregnancies will end naturally and there will be no need for an operation or a drug to treat the condition. […] Doctors always consider the least invasive form of treatment or management first where they can. […] An ectopic pregnancy can be life-threatening for a woman or pregnant person and so must be diagnosed and treated quickly.

• #11 Ectopic Pregnancy: Signs, Treatment and SupportCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support

  The treatment you are offered will depend on different things, including: […] how many weeks pregnant you are, […] your symptoms, […] the results of any scans and blood tests, […] how much pain you are in, […] your pregnancy hormone levels and how they are changing, […] the options available at your local hospital, […] your own preference. […] In most cases, you can plan your treatment. Your healthcare team will discuss your options with you. They should explain the pros and cons of each option and answer any questions you might have. […] If your fallopian tube is ruptured, you will need emergency surgery. This is because of the risk of severe bleeding which could be life-threatening. […] You may be able to wait and see if the ectopic pregnancy ends by itself (expectant management). You are likely to have some vaginal bleeding after the ectopic pregnancy ends. Use pads or period pants rather than tampons or menstrual cups.

• #12 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #13 Ectopic Pregnancy: Signs, Treatment and SupportCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support

  Your healthcare team will check your pregnancy hormone levels to decide if this option is safe for you. They will continue to monitor you throughout expectant management. […] If your ectopic pregnancy does not end by itself, your doctor will talk to you about the options below. […] During medical treatment, a drug (methotrexate) is injected into your buttock. This stops your pregnancy from growing. After the pregnancy has ended, you are likely to have some vaginal bleeding. […] Most women only need 1 injection of methotrexate. 15 in 100 women and birthing people need a second injection. 29 out of 100 women and birthing people may need surgery even after medical treatment. This is more likely if your pregnancy is beyond the very early stages. It may also happen if your pregnancy hormone levels are very high.

• #14 Ectopic Pregnancy Treatment, Surgery, & Recovery Time

  https://www.webmd.com/baby/treatment-for-ectopic-pregnancy

  An ectopic pregnancy occurs when a fertilized egg implants itself outside of the uterus. […] A pregnancy cant 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 youre 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. […] 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.

• #15 Ectopic Pregnancy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html

  Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. […] Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management. […] A patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability, if the initial beta human chorionic gonadotropin level is high, if fetal cardiac activity is detected outside of the uterus on ultrasonography, or if there is a contraindication to medical management. […] Intramuscular methotrexate is the only medication appropriate for the management of ectopic pregnancy.

• #16 Ectopic Pregnancy Treatment & Management: Approach Considerations, Expectant Management, Methotrexate Therapy

  https://emedicine.medscape.com/article/2041923-treatment

  The Society for Maternal-Fetal Medicine (SMFM) advises against expectant management of cesarean scar ectopic pregnancies. […] Methotrexate is an antimetabolite chemotherapeutic agent that binds to the enzyme dihydrofolate reductase, which is involved in the synthesis of purine nucleotides. This interferes with deoxyribonucleic acid (DNA) synthesis and disrupts cell multiplication. […] Successful medical treatment using methotrexate has been reported in the literature with good subsequent reproductive outcomes. By avoiding surgery, the risk of tubal injury is reduced. […] Medical therapy for ectopic pregnancy involving methotrexate may be indicated in certain patients. […] A -HCG level of greater than 5,000 IU/L, fetal cardiac activity, and free fluid in the cul-de-sac on ultrasonographic images (presumably representing tubal rupture) are contraindications to medical therapy with methotrexate.

• #17 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #18 Diagnosis and management of ectopic pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3213855/

  Ectopic pregnancy is one of the few medical conditions that can be managed expectantly, medically or surgically. […] Ectopic pregnancy may be managed surgically, medically or expectantly. […] Surgical management is imperative in the clinical scenario of a ruptured ectopic pregnancy. A laparoscopic approach is preferable to an open approach in a patient who is haemodynamically stable. […] Medical treatment is useful for patients with an unruptured tubal ectopic pregnancy who are haemodynamically stable and have minimal symptoms and a low volume of free intraperitoneal fluid on ultrasound scan. […] Medical management with methotrexate is successful for small, stable ectopic pregnancies. […] Some ectopic pregnancies resolve spontaneously through either regression or tubal abortion, without causing harm to the patient. Expectant management is a conservative strategy consisting of observation and assessment of whether the ectopic pregnancy is continuing to resolve spontaneously and successfully without intervention.

• #19 Ectopic Pregnancy Treatment, Surgery, & Recovery Time

  https://www.webmd.com/baby/treatment-for-ectopic-pregnancy

  Women used to stay in the hospital for a series of methotrexate injections. Now its 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. […] If methotrexate therapy doesnt work, surgery is the next step. […] Its 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. […] After surgery, your doctors will watch your hCG levels to make sure theyre going down and the pregnancy was removed properly. Some women also need a methotrexate injection so everything returns to normal.

• #20 Ectopic Pregnancy: Definition, Symptoms, Treatment, Ultrasound, Risk Factors

  https://www.medicinenet.com/ectopic_pregnancy/article.htm

  What are the treatments for ectopic pregnancy? Treatment options for ectopic pregnancy include observation, laparoscopy, laparotomy, and medication. The selection of these options is individualized. […] For those who require intervention, the most common treatment is surgery. Two surgical options are available; laparotomy and laparoscopy. […] Laparotomy is an open procedure whereby a transverse (bikini line) incision is made across the lower abdomen. […] Laparoscopy involves inserting viewing instruments into the pelvis through tiny incisions in the skin. […] Medical therapy can also be successful in treating certain groups of women who have an ectopic pregnancy. The medical treatment method involves the use of an anti-cancer drug called methotrexate (Rheumatrex, Trexall). This drug acts by killing the growing cells of the placenta, thereby inducing miscarriage of the ectopic pregnancy. […] The optimal candidates for methotrexate treatment are women with a beta-subunit (HCG) concentration less than or equal to 5000 mIU/mL. In a properly selected patient population, methotrexate therapy is about 90% effective in treating ectopic pregnancy.

• #21 Ectopic Pregnancy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html

  Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. […] Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management. […] A patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability, if the initial beta human chorionic gonadotropin level is high, if fetal cardiac activity is detected outside of the uterus on ultrasonography, or if there is a contraindication to medical management. […] Intramuscular methotrexate is the only medication appropriate for the management of ectopic pregnancy.

• #22 Ectopic Pregnancy | ACOG

  https://www.acog.org/womens-health/faqs/ectopic-pregnancy

  An ectopic pregnancy cannot move or be moved to the uterus, so it always requires treatment. There are two methods used to treat an ectopic pregnancy: 1) medication and 2) surgery. Several weeks of follow-up are required with each treatment. […] The most common drug used to treat ectopic pregnancy is methotrexate. This drug stops cells from growing, which ends the pregnancy. The pregnancy then is absorbed by the body over 4-6 weeks. This does not require the removal of the fallopian tube. […] Methotrexate may be used if the pregnancy has not ruptured a fallopian tube. Several factors go into the decision to use methotrexate. One of the most important factors is your ability to follow up with blood tests that check your blood levels of hCG. You will not be able to use methotrexate if you are breastfeeding or have certain health problems.

• #23 Ectopic Pregnancy Treatment & Management: Approach Considerations, Expectant Management, Methotrexate Therapy

  https://emedicine.medscape.com/article/2041923-treatment

  Adverse effects associated with the use of methotrexate can be divided into adverse drug effects and treatment effects. […] The medical treatment of ectopic pregnancy requires compulsive compliance. […] A number of accepted protocols with injected methotrexate exist for the treatment of ectopic pregnancy. […] The more popular regimen today is the single-dose injection, which involves injection of methotrexate as 50 mg/m2 IM in a single injection or as a divided dose injected into each buttock. […] The best predictor of success of medical therapy is the initial -HCG level. […] Failure of medical treatment is defined when -HCG levels increase, plateau, or fail to decrease adequately by 15% from days 4 to 7 postinjection. At this time, surgical intervention may be warranted. […] The use of oral methotrexate is under investigation; although preliminary reports show promising results, efficacy remains to be established.

• #24 Diagnosis and management of ectopic pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3213855/

  In the presence of contralateral tubal disease, a laparoscopic salpingostomy should be considered if future fertility is desired. Persistent trophoblast is the main concern after a salpingostomy. […] Methotrexate is a folic acid antagonist that targets rapidly dividing cells and arrests mitosis. […] The commonly used single-dose methotrexate treatment regimen involves a deep intramuscular injection at a dose of 50 mg/m2 of the calculated body surface area. […] Two much less common uses of methotrexate for the treatment of ectopic gestation are the multi-dose protocol and direct injection of methotrexate into the ectopic pregnancy. […] A number of systematic reviews have examined reproductive outcomes following the two procedures in patients with a healthy contralateral tube.

• #25 Ectopic Pregnancy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html

  Several methotrexate regimens have been studied, including a single-dose protocol, a two-dose protocol, and a multi-dose protocol. […] The single-dose protocol carries the lowest risk of adverse effects, whereas the two-dose protocol is more effective than the single-dose protocol in patients with higher initial -hCG levels. […] Overall, surgical management has a higher success rate for ectopic pregnancy than methotrexate. […] Surgical options include salpingostomy or salpingectomy. […] Expectant management can be considered for patients whose peak -hCG level is below the discriminatory zone and is decreasing, but has plateaued or is decreasing more slowly than expected for a failed intrauterine pregnancy.

• #26 Medical Management of Ectopic Pregnancy

  https://www.exxcellence.org/list-of-pearls/medical-management-of-ectopic-pregnancy/?categoryName=&searchTerms=&featured=False&bookmarked=False&sortColumn=date&sortDirection=Descending

  When there is high clinical suspicion or diagnosis of an ectopic pregnancy, the patient should be counseled regarding surgical or medical treatment. […] Several additional relative contraindications to methotrexate have been suggested, likely because they foreshadow a decreased rate of successful treatment. […] Recommended baseline screening includes a thorough history and physical examination, complete blood cell count, liver function tests, serum creatinine measurement, determination of blood type and Rh, and hCG measurement. […] A recent meta-analysis documented that the 2-dose regimen had a significantly higher rate of treatment success and lower rate of treatment failure when compared with the single-dose regimen. While not statistically significant, the multidose regimen also trended toward improved outcomes as compared with outcomes of the single-dose regimen. Despite greater treatment success in these groups, adverse effects were also more prevalent as the dose of methotrexate accumulated. Given these data, a reasonable approach is to reserve the multidose regimen for ectopic pregnancies at higher risk for treatment failure and to use the 2-dose or single-dose regimens as first-line therapy.

• #27 Ectopic Pregnancy: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/2041923-overview

  The success rates after methotrexate are comparable with laparoscopic salpingostomy, assuming that the previously mentioned selection criteria are observed. […] Comparison of medical and surgical treatment of small, intact extrauterine pregnancies also revealed similar success and subsequent spontaneous pregnancy rates in a prospective, randomized trial. […] A meta-analysis that included data from 26 trials demonstrated a success rate of 88.1% with the single-dose methotrexate regimen and a success rate of 92.7% with the multiple-dose regimen. […] Complications of ectopic pregnancy can be secondary to misdiagnosis, late diagnosis, or treatment approach. Failure to make the prompt and correct diagnosis of ectopic pregnancy can result in tubal or uterine rupture, which in turn can lead to massive hemorrhage, shock, disseminated intravascular coagulopathy (DIC), and death.

• #28 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #29 Ectopic Pregnancy: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/2041923-overview

  The success rates after methotrexate are comparable with laparoscopic salpingostomy, assuming that the previously mentioned selection criteria are observed. […] Comparison of medical and surgical treatment of small, intact extrauterine pregnancies also revealed similar success and subsequent spontaneous pregnancy rates in a prospective, randomized trial. […] A meta-analysis that included data from 26 trials demonstrated a success rate of 88.1% with the single-dose methotrexate regimen and a success rate of 92.7% with the multiple-dose regimen. […] Complications of ectopic pregnancy can be secondary to misdiagnosis, late diagnosis, or treatment approach. Failure to make the prompt and correct diagnosis of ectopic pregnancy can result in tubal or uterine rupture, which in turn can lead to massive hemorrhage, shock, disseminated intravascular coagulopathy (DIC), and death.

• #30 Ectopic Pregnancy Treatment & Management: Approach Considerations, Expectant Management, Methotrexate Therapy

  https://emedicine.medscape.com/article/2041923-treatment

  Adverse effects associated with the use of methotrexate can be divided into adverse drug effects and treatment effects. […] The medical treatment of ectopic pregnancy requires compulsive compliance. […] A number of accepted protocols with injected methotrexate exist for the treatment of ectopic pregnancy. […] The more popular regimen today is the single-dose injection, which involves injection of methotrexate as 50 mg/m2 IM in a single injection or as a divided dose injected into each buttock. […] The best predictor of success of medical therapy is the initial -HCG level. […] Failure of medical treatment is defined when -HCG levels increase, plateau, or fail to decrease adequately by 15% from days 4 to 7 postinjection. At this time, surgical intervention may be warranted. […] The use of oral methotrexate is under investigation; although preliminary reports show promising results, efficacy remains to be established.

• #31 Diagnosis and treatment of ectopic pregnancy | British Columbia Medical Journal

  https://bcmj.org/articles/diagnosis-and-treatment-ectopic-pregnancy

  Early diagnosis of ectopic pregnancy is critical to reducing maternal mortality and improving treatment success rates, especially since many women have no identifiable risk factors. […] Expectant management of ectopic pregnancy involves allowing the pregnancy to take its natural course with close physician follow-up until there is clinical resolution of symptoms, a negative urine pregnancy test, or negative serum b-hCG. There is evidence that expectant management of ectopic pregnancy can be a safe option in a select population of women who are hemodynamically stable, asymptomatic, have a b-hCG value less than 1000 IU/L, with decreasing levels, and can reliably access regular physician follow-up. […] Methotrexate, the most common option for treating ectopic pregnancy, was first used for this purpose in 1982. It is a folate antagonist that prevents DNA replication and affects rapidly proliferating cells like that of a developing embryo. A single dose of methotrexate is administered intramuscularly based on body surface area (50 mg/m2). Its effectiveness is assessed by serial b-hCG measurements on days 4 and 7 post-treatment, then weekly until resolution. A reduction of less than 15% in b-hCG level between days 4 and 7 posttreatment may indicate that treatment is inadequate; therefore, a second dose of methotrexate might be required.

• #32

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10071153/

  Intramuscular (IM) MTX injection is the current standard for medical management of EPs. […] MTX is administered in single, double, or multi-dose regimens. […] Common side effects of MTX treatment include vaginal spotting and gastrointestinal issues such as nausea, diarrhea, and vomiting. […] Salpingostomy and salpingectomy are the two common approaches for surgical management of EPs. […] Expectant management is the most conservative approach for the treatment of EPs. […] Innovations in surgical management of EPs may provide better immediate and future fertility outcomes. […] Psychological interventions are also important to consider in the management of EPs.

• #33 Patient education: Ectopic (tubal) pregnancy (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/ectopic-tubal-pregnancy-beyond-the-basics/print

  ECTOPIC PREGNANCY TREATMENT […] Once an ectopic pregnancy is diagnosed, it must be treated to stop its growth; observation or „watch and wait” treatment is rarely recommended, because the life of the pregnant person is at risk if treatment is delayed. Treatment is started as soon as a diagnosis of ectopic pregnancy is confirmed and includes either medication or surgery. […] Medical management — Most people with ectopic pregnancies can be treated with a medication called methotrexate, which stops the growth of the embryo. It is given in an intramuscular injection. After the injection, the pregnant person may experience abdominal pain or cramps, which can usually be controlled with acetaminophen (sample brand name: Tylenol). Nonsteroidal anti-inflammatory drugs, or „NSAIDS” (eg, ibuprofen [sample brand names: Advil, Motrin] or naproxen [sample brand names: Aleve, Naprosyn]), should be avoided due to the risk of an interaction between NSAIDs and methotrexate.

• #34 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #35 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #36 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #37 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Expectant management is between 47 and 82 percent effective in managing ectopic pregnancy. A good candidate for expectant management has a beta-hCG level less than 1,000 mIU per mL (1,000 IU per L) and declining, an ectopic mass less than 3 cm, no fetal heartbeat, and has agreed to comply with follow-up requirements. […] Methotrexate, a folic acid antagonist, is a well-studied medical therapy. Methotrexate deactivates dihydrofolate reductase, which reduces tetrahydrofolate levels (a cofactor for deoxyribonucleic acid and ribonucleic acid synthesis), thereby disrupting rapidly-dividing trophoblastic cells. Other therapeutic agents include hyperosmolar glucose, prostaglandins, and mifepristone (Mifeprex). […] Protocols for methotrexate therapy include single-dose and multiple-dose regimens. Although no studies have compared the protocols, the single-dose regimen is easier to administer and is used more often. In a 2003 meta-analysis of methotrexate therapies, 20 studies examined the single-dose regimen, and six examined the multiple-dose regimen. The single-dose regimen created fewer side effects but was slightly less effective, with a crude overall success rate of 88 percent compared with the multiple-dose regimen’s 93 percent success rate. Methotrexate, regardless of the protocol, had an overall 89 percent crude success rate. Side effects of methotrexate include bone marrow suppression, elevated liver enzymes, rash, alopecia, stomatitis, nausea, and diarrhea. The time to resolution of the ectopic pregnancy is three to seven weeks after methotrexate therapy.

• #38 Ectopic Pregnancy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html

  Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. […] Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management. […] A patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability, if the initial beta human chorionic gonadotropin level is high, if fetal cardiac activity is detected outside of the uterus on ultrasonography, or if there is a contraindication to medical management. […] Intramuscular methotrexate is the only medication appropriate for the management of ectopic pregnancy.

• #39 Ectopic pregnancy – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093

  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. […] 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. […] 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. […] 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.

• #40 Ectopic Pregnancy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html

  Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. […] Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management. […] A patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability, if the initial beta human chorionic gonadotropin level is high, if fetal cardiac activity is detected outside of the uterus on ultrasonography, or if there is a contraindication to medical management. […] Intramuscular methotrexate is the only medication appropriate for the management of ectopic pregnancy.

• #41 Ectopic Pregnancy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html

  Ectopic pregnancy should be considered in any patient presenting early in pregnancy with vaginal bleeding or lower abdominal pain in whom intrauterine pregnancy has not yet been established. […] Treatment of diagnosed ectopic pregnancy includes medical management with intramuscular methotrexate, surgical management via salpingostomy or salpingectomy, and, in rare cases, expectant management. […] A patient with diagnosed ectopic pregnancy should be immediately transferred for surgery if she has peritoneal signs or hemodynamic instability, if the initial beta human chorionic gonadotropin level is high, if fetal cardiac activity is detected outside of the uterus on ultrasonography, or if there is a contraindication to medical management. […] Intramuscular methotrexate is the only medication appropriate for the management of ectopic pregnancy.

• #42 Ectopic Pregnancy Treatment, Surgery, & Recovery Time

  https://www.webmd.com/baby/treatment-for-ectopic-pregnancy

  Women used to stay in the hospital for a series of methotrexate injections. Now its 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. […] If methotrexate therapy doesnt work, surgery is the next step. […] Its 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. […] After surgery, your doctors will watch your hCG levels to make sure theyre going down and the pregnancy was removed properly. Some women also need a methotrexate injection so everything returns to normal.

• #43 Ectopic Pregnancy Treatment, Surgery, & Recovery Time

  https://www.webmd.com/baby/treatment-for-ectopic-pregnancy

  Women used to stay in the hospital for a series of methotrexate injections. Now its 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. […] If methotrexate therapy doesnt work, surgery is the next step. […] Its 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. […] After surgery, your doctors will watch your hCG levels to make sure theyre going down and the pregnancy was removed properly. Some women also need a methotrexate injection so everything returns to normal.

• #44 Ectopic Pregnancy: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/2041923-overview

  Ectopic pregnancy is the result of a flaw in human reproductive physiology that allows the conceptus to implant and mature outside the endometrial cavity, which ultimately ends in the death of the fetus. Without timely diagnosis and treatment, ectopic pregnancy can become a life-threatening situation. […] Therapeutic options in ectopic pregnancy are as follows: Expectant management, Methotrexate, Surgery. […] Methotrexate is the standard medical treatment for unruptured ectopic pregnancy. A single-dose IM injection is the more popular regimen. […] Laparoscopy has become the recommended surgical approach in most cases. […] The modern pelvic surgeon has been led to believe that the treatment of choice for unruptured ectopic pregnancy is salpingostomy, sparing the affected fallopian tube and thereby improving future reproductive outcome.

• #45 Diagnosis and management of ectopic pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3213855/

  Ectopic pregnancy is one of the few medical conditions that can be managed expectantly, medically or surgically. […] Ectopic pregnancy may be managed surgically, medically or expectantly. […] Surgical management is imperative in the clinical scenario of a ruptured ectopic pregnancy. A laparoscopic approach is preferable to an open approach in a patient who is haemodynamically stable. […] Medical treatment is useful for patients with an unruptured tubal ectopic pregnancy who are haemodynamically stable and have minimal symptoms and a low volume of free intraperitoneal fluid on ultrasound scan. […] Medical management with methotrexate is successful for small, stable ectopic pregnancies. […] Some ectopic pregnancies resolve spontaneously through either regression or tubal abortion, without causing harm to the patient. Expectant management is a conservative strategy consisting of observation and assessment of whether the ectopic pregnancy is continuing to resolve spontaneously and successfully without intervention.

• #46 Ectopic Pregnancy | ACOG

  https://www.acog.org/womens-health/faqs/ectopic-pregnancy

  If the ectopic pregnancy has ruptured a tube, emergency surgery is needed. Sometimes surgery is needed even if the fallopian tube has not ruptured. In these cases, the ectopic pregnancy can be removed from the tube, or the entire tube with the pregnancy can be removed. […] Surgery typically is done with laparoscopy. This procedure uses a slender, lighted camera that is inserted through small cuts in the abdomen. It is done in a hospital with general anesthesia. […] Your ob-gyn or other health care professional will talk with you about the possible side effects and risks of surgery for ectopic pregnancy. These may include pain, fatigue, bleeding, and infection.

• #47 Ectopic pregnancy treatment – USZ

  https://www.usz.ch/en/department/gynecology/service/ectopic-pregnancy-treatment/

  Surgery is performed in the event of pain or if there is evidence of internal bleeding during the ultrasound. This is primarily done using a buttonhole technique. The standard procedure is ectopic pregnancy removal by laparoscopy. Open surgery i.e. by means of an abdominal incision (laparotomy) is only performed if laparoscopy is not possible for technical or medical reasons. […] There are two options for removing an ectopic pregnancy: Salpingotomy and salpingectomy. In a salpingotomy, the fallopian tube is preserved and only the pregnancy tissue is removed through a small incision in the fallopian tube wall. In a salpingectomy, on the other hand, the entire fallopian tube is removed along with the pregnancy. This is necessary in situations where the fallopian tube has been completely destroyed by the pregnancy and/or the bleeding cannot be stopped any further.

• #48 Diagnosis and management of ectopic pregnancy

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3213855/

  In the presence of contralateral tubal disease, a laparoscopic salpingostomy should be considered if future fertility is desired. Persistent trophoblast is the main concern after a salpingostomy. […] Methotrexate is a folic acid antagonist that targets rapidly dividing cells and arrests mitosis. […] The commonly used single-dose methotrexate treatment regimen involves a deep intramuscular injection at a dose of 50 mg/m2 of the calculated body surface area. […] Two much less common uses of methotrexate for the treatment of ectopic gestation are the multi-dose protocol and direct injection of methotrexate into the ectopic pregnancy. […] A number of systematic reviews have examined reproductive outcomes following the two procedures in patients with a healthy contralateral tube.

• #49 Diagnosis and treatment of ectopic pregnancy | British Columbia Medical Journal

  https://bcmj.org/articles/diagnosis-and-treatment-ectopic-pregnancy

  With improved laparoscopic instruments and techniques, minimally invasive surgery has become the gold standard for treating ectopic pregnancy and has mostly replaced laparotomy. Laparoscopic surgery offers a safer, faster, cheaper, and more esthetic option. […] Given that salpingotomy requires the surgeon to meticulously extract a small trophoblastic mass while preserving the fallopian tube, the method might be prone to trophoblastic tissue retention, which can necessitate a salpingectomy. […] Thus, for women with tubal pregnancy and a healthy contralateral tube, salpingectomy is a reasonable treatment option because it minimizes risk of ectopic mass persistence and does not seem to reduce future fertility. However, for women with contralateral tubal pathology or no contralateral tube, conservative treatment with salpingotomy should be considered if they wish to maintain the potential for natural conception. […] Patients who are asymptomatic and hemodynamically stable can be managed with either intramuscular methotrexate or laparoscopic surgery. The decision should be guided by patient characteristics, laboratory and radiological findings, and patient preference after discussion of the risks and benefits.

• #50 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Before the advent of laparoscopy, laparotomy with salpingectomy (removal of the fallopian tube through an abdominal incision) was the standard therapy for managing ectopic pregnancy. Laparoscopy with salpingostomy, without fallopian tube removal, has become the preferred method of surgical treatment. Laparoscopy has similar tubal patency and future fertility rates as medical treatment. Salpingostomy has an estimated 8 to 9 percent failure rate, which can be managed with methotrexate. […] During treatment, physicians should examine patients at least weekly and sometimes daily. Serial beta-hCG measurements should be taken after treatment until the level is undetectable. If the levels fail to decline, the patient can be treated with a second course of methotrexate or with methotrexate post-surgery. Surgical intervention is necessary if beta-hCG levels increase. […] The prognosis is good for patients who receive appropriate treatment. With proper patient selection, success rates approach 82 percent for expectant management, 90 percent for medical management, and 92 percent for surgical management.

• #51 Patient education: Ectopic (tubal) pregnancy (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/ectopic-tubal-pregnancy-beyond-the-basics/print

  Will my fallopian tube be removed? — During surgery, it is sometimes possible to remove the ectopic pregnancy and repair the tube (called salpingostomy). […] In other cases, it is necessary to remove the fallopian tube (called salpingectomy). This may be required if there is uncontrolled bleeding, recurrent ectopic pregnancy in the same tube, a severely damaged tube, or a large tubal pregnancy. It may also be performed in people who have completed childbearing. If the remaining opposite tube is normal, the chance of a subsequent healthy pregnancy is good. […] In a small number of people treated surgically, embryonic tissue may still be present after surgery and cause the hCG level to remain elevated. A dose of methotrexate may be given if this occurs.

• #52 Ectopic pregnancy treatment – USZ

  https://www.usz.ch/en/department/gynecology/service/ectopic-pregnancy-treatment/

  Surgery is performed in the event of pain or if there is evidence of internal bleeding during the ultrasound. This is primarily done using a buttonhole technique. The standard procedure is ectopic pregnancy removal by laparoscopy. Open surgery i.e. by means of an abdominal incision (laparotomy) is only performed if laparoscopy is not possible for technical or medical reasons. […] There are two options for removing an ectopic pregnancy: Salpingotomy and salpingectomy. In a salpingotomy, the fallopian tube is preserved and only the pregnancy tissue is removed through a small incision in the fallopian tube wall. In a salpingectomy, on the other hand, the entire fallopian tube is removed along with the pregnancy. This is necessary in situations where the fallopian tube has been completely destroyed by the pregnancy and/or the bleeding cannot be stopped any further.

• #53 Review of Ectopic Pregnancy treatment for IVF patients

  https://www.immunologyresearchjournal.com/articles/review-of-ectopic-pregnancy-treatment-for-ivf-patients.html

  Salpingostomy is indicated for hemodynamically stable patients with unruptured EP. […] Salpingectomy is indicated in patients with uncontrolled bleeding, recurrent EP in the same fallopian tube or extensive tubal damage. […] It appears that MTX has similar recurrence rate of EP with salpingectomy and salpingostomy both in pregnancies after natural conception and pregnancies that resulted from IVF. […] Based in the available evidence, MTX may be considered as the first-line therapy of EP in patients with an early, unruptured EP, even for patient undergoing IVF treatment.

• #54 Ectopic Pregnancy: Signs, Treatment and SupportCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support

  You may need to stay in hospital overnight after your injection. You may also need more blood tests until your hormone levels show the pregnancy has ended. […] Treatment of ectopic pregnancy with methotrexate is not known to affect your ability to produce eggs. […] If treatment is successful, it means you will not need to have your fallopian tube removed. […] There are two types of surgery for ectopic pregnancy. Both are carried out under general anaesthetic. […] Keyhole surgery (known as laparoscopy). […] Open surgery (known as a laparotomy). This is done through a larger cut in your abdomen. You may need open surgery if doctors suspect you have severe internal bleeding. […] The aim of surgery is to remove the ectopic pregnancy. The type of operation you have will depend on your wishes or plans for a future pregnancy and what your surgeon finds during the operation.

• #55 Patient education: Ectopic (tubal) pregnancy (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/ectopic-tubal-pregnancy-beyond-the-basics/print

  • Those who are unable or unwilling to return for monitoring after methotrexate therapy. […] • Those who would normally be a candidate for medical treatment, but who could not reach a hospital (due to lack of transportation or distance to an appropriate health care facility) in the event of tubal rupture during medical therapy. […] How is surgery performed? — Surgery may be performed using a laparoscopic approach or through an abdominal incision. In laparoscopy, instruments are inserted into the abdomen through a few small incisions. These instruments are used to see and remove the ectopic pregnancy and control bleeding. Compared with abdominal surgery, laparoscopic surgery causes less pain and allows for a faster recovery. […] In an abdominal procedure, a surgeon opens the abdomen using a single larger incision to directly see and remove the ectopic pregnancy.

• #56 Ectopic Pregnancy Causes, Symptoms, and Treatments

  https://www.upmc.com/services/womens-health/conditions/ectopic-pregnancy

  A ruptured ectopic pregnancy requires emergency surgery. This is typically with an abdominal incision in a procedure called a laparotomy. […] Many people who’ve had an ectopic pregnancy are able to have a successful pregnancy after treatment. But you should wait at least two to three months after medication or surgery before trying to get pregnant again.

• #57 Ectopic Pregnancy | ACOG

  https://www.acog.org/womens-health/faqs/ectopic-pregnancy

  If the ectopic pregnancy has ruptured a tube, emergency surgery is needed. Sometimes surgery is needed even if the fallopian tube has not ruptured. In these cases, the ectopic pregnancy can be removed from the tube, or the entire tube with the pregnancy can be removed. […] Surgery typically is done with laparoscopy. This procedure uses a slender, lighted camera that is inserted through small cuts in the abdomen. It is done in a hospital with general anesthesia. […] Your ob-gyn or other health care professional will talk with you about the possible side effects and risks of surgery for ectopic pregnancy. These may include pain, fatigue, bleeding, and infection.

• #58 Ectopic Pregnancy | ACOG

  https://www.acog.org/womens-health/faqs/ectopic-pregnancy

  If the ectopic pregnancy has ruptured a tube, emergency surgery is needed. Sometimes surgery is needed even if the fallopian tube has not ruptured. In these cases, the ectopic pregnancy can be removed from the tube, or the entire tube with the pregnancy can be removed. […] Surgery typically is done with laparoscopy. This procedure uses a slender, lighted camera that is inserted through small cuts in the abdomen. It is done in a hospital with general anesthesia. […] Your ob-gyn or other health care professional will talk with you about the possible side effects and risks of surgery for ectopic pregnancy. These may include pain, fatigue, bleeding, and infection.

• #59 Ectopic Pregnancy: Practice Essentials, Background, Etiology

  https://emedicine.medscape.com/article/2041923-overview

  The success rates after methotrexate are comparable with laparoscopic salpingostomy, assuming that the previously mentioned selection criteria are observed. […] Comparison of medical and surgical treatment of small, intact extrauterine pregnancies also revealed similar success and subsequent spontaneous pregnancy rates in a prospective, randomized trial. […] A meta-analysis that included data from 26 trials demonstrated a success rate of 88.1% with the single-dose methotrexate regimen and a success rate of 92.7% with the multiple-dose regimen. […] Complications of ectopic pregnancy can be secondary to misdiagnosis, late diagnosis, or treatment approach. Failure to make the prompt and correct diagnosis of ectopic pregnancy can result in tubal or uterine rupture, which in turn can lead to massive hemorrhage, shock, disseminated intravascular coagulopathy (DIC), and death.

• #60

  https://www.nhs.uk/conditions/ectopic-pregnancy/

  There are 3 main treatments for an ectopic pregnancy: […] an injection of a powerful medicine called methotrexate is used to stop the pregnancy growing […] keyhole surgery (laparoscopy) is performed under general anaesthetic to remove the fertilised egg, usually along with the affected fallopian tube. […] You’ll be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have. […] Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant. Talk to your doctor about this.

• #61 Ectopic pregnancy: Future fertility – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ectopic-pregnancy-signs-treatment-and-future-fertility

  Most women who experience ectopic pregnancy and treatment will achieve a successful pregnancy in the future, even if they’ve lost one fallopian tube as part of the therapy. There is a 10% risk of recurrence, which is why it’s important to work with your health care team when planning for a future pregnancy. Also, early documentation of an intrauterine gestational sac is of paramount importance. […] Studies that have looked at the difference in fertility after treatment of ectopic pregnancy showed that medical treatment of early ectopic pregnancies with medication, compared to surgical treatments sparing the fallopian tube, had no adverse fertility outcome. […] Also, women who were treated with surgery that spared the fallopian tubes and fallopian tube removal surgery had almost the same rate of pregnancy after treatment, given the other fallopian tube is healthy.

• #62 Diagnosis and Management of Ectopic Pregnancy | AAFP

  https://www.aafp.org/pubs/afp/issues/2005/1101/p1707.html

  Before the advent of laparoscopy, laparotomy with salpingectomy (removal of the fallopian tube through an abdominal incision) was the standard therapy for managing ectopic pregnancy. Laparoscopy with salpingostomy, without fallopian tube removal, has become the preferred method of surgical treatment. Laparoscopy has similar tubal patency and future fertility rates as medical treatment. Salpingostomy has an estimated 8 to 9 percent failure rate, which can be managed with methotrexate. […] During treatment, physicians should examine patients at least weekly and sometimes daily. Serial beta-hCG measurements should be taken after treatment until the level is undetectable. If the levels fail to decline, the patient can be treated with a second course of methotrexate or with methotrexate post-surgery. Surgical intervention is necessary if beta-hCG levels increase. […] The prognosis is good for patients who receive appropriate treatment. With proper patient selection, success rates approach 82 percent for expectant management, 90 percent for medical management, and 92 percent for surgical management.

• #63 Open Search

  https://www.plannedparenthood.org/learn/pregnancy/ectopic-pregnancy

  Ectopic pregnancy is when a pregnancy grows outside of your uterus, usually in your fallopian tube. Ectopic pregnancies are rare but serious, and they need to be treated. […] Most people who have an ectopic pregnancy can have healthy pregnancies in the future, depending on the treatment you had and the condition of your fallopian tubes. […] If you have an ectopic pregnancy, you’re more likely to get another one in the future. […] No, a doctor can’t re-implant or move your ectopic pregnancy into your uterus. Ectopic pregnancies can’t grow into fetuses: A pregnancy won’t survive if it’s ectopic, because a fertilized egg can’t grow or survive outside your uterus. […] Untreated ectopic pregnancies can cause internal bleeding, infection, and in some cases lead to death. When you have an ectopic pregnancy, it’s extremely important to get treatment from a doctor as soon as possible.

• #64 Ectopic pregnancy: Future fertility – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ectopic-pregnancy-signs-treatment-and-future-fertility

  Most women who experience ectopic pregnancy and treatment will achieve a successful pregnancy in the future, even if they’ve lost one fallopian tube as part of the therapy. There is a 10% risk of recurrence, which is why it’s important to work with your health care team when planning for a future pregnancy. Also, early documentation of an intrauterine gestational sac is of paramount importance. […] Studies that have looked at the difference in fertility after treatment of ectopic pregnancy showed that medical treatment of early ectopic pregnancies with medication, compared to surgical treatments sparing the fallopian tube, had no adverse fertility outcome. […] Also, women who were treated with surgery that spared the fallopian tubes and fallopian tube removal surgery had almost the same rate of pregnancy after treatment, given the other fallopian tube is healthy.

• #65 Ectopic Pregnancy: Signs, Treatment and SupportCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support

  Your healthcare team will check your pregnancy hormone levels to decide if this option is safe for you. They will continue to monitor you throughout expectant management. […] If your ectopic pregnancy does not end by itself, your doctor will talk to you about the options below. […] During medical treatment, a drug (methotrexate) is injected into your buttock. This stops your pregnancy from growing. After the pregnancy has ended, you are likely to have some vaginal bleeding. […] Most women only need 1 injection of methotrexate. 15 in 100 women and birthing people need a second injection. 29 out of 100 women and birthing people may need surgery even after medical treatment. This is more likely if your pregnancy is beyond the very early stages. It may also happen if your pregnancy hormone levels are very high.

• #66 Ectopic pregnancy: Future fertility – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ectopic-pregnancy-signs-treatment-and-future-fertility

  Most women who experience ectopic pregnancy and treatment will achieve a successful pregnancy in the future, even if they’ve lost one fallopian tube as part of the therapy. There is a 10% risk of recurrence, which is why it’s important to work with your health care team when planning for a future pregnancy. Also, early documentation of an intrauterine gestational sac is of paramount importance. […] Studies that have looked at the difference in fertility after treatment of ectopic pregnancy showed that medical treatment of early ectopic pregnancies with medication, compared to surgical treatments sparing the fallopian tube, had no adverse fertility outcome. […] Also, women who were treated with surgery that spared the fallopian tubes and fallopian tube removal surgery had almost the same rate of pregnancy after treatment, given the other fallopian tube is healthy.

• #67 Diagnosis and treatment of ectopic pregnancy | British Columbia Medical Journal

  https://bcmj.org/articles/diagnosis-and-treatment-ectopic-pregnancy

  With improved laparoscopic instruments and techniques, minimally invasive surgery has become the gold standard for treating ectopic pregnancy and has mostly replaced laparotomy. Laparoscopic surgery offers a safer, faster, cheaper, and more esthetic option. […] Given that salpingotomy requires the surgeon to meticulously extract a small trophoblastic mass while preserving the fallopian tube, the method might be prone to trophoblastic tissue retention, which can necessitate a salpingectomy. […] Thus, for women with tubal pregnancy and a healthy contralateral tube, salpingectomy is a reasonable treatment option because it minimizes risk of ectopic mass persistence and does not seem to reduce future fertility. However, for women with contralateral tubal pathology or no contralateral tube, conservative treatment with salpingotomy should be considered if they wish to maintain the potential for natural conception. […] Patients who are asymptomatic and hemodynamically stable can be managed with either intramuscular methotrexate or laparoscopic surgery. The decision should be guided by patient characteristics, laboratory and radiological findings, and patient preference after discussion of the risks and benefits.

• #68 Ectopic pregnancy: Future fertility – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ectopic-pregnancy-signs-treatment-and-future-fertility

  Most women who experience ectopic pregnancy and treatment will achieve a successful pregnancy in the future, even if they’ve lost one fallopian tube as part of the therapy. There is a 10% risk of recurrence, which is why it’s important to work with your health care team when planning for a future pregnancy. Also, early documentation of an intrauterine gestational sac is of paramount importance. […] Studies that have looked at the difference in fertility after treatment of ectopic pregnancy showed that medical treatment of early ectopic pregnancies with medication, compared to surgical treatments sparing the fallopian tube, had no adverse fertility outcome. […] Also, women who were treated with surgery that spared the fallopian tubes and fallopian tube removal surgery had almost the same rate of pregnancy after treatment, given the other fallopian tube is healthy.

• #69 Patient education: Ectopic (tubal) pregnancy (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/ectopic-tubal-pregnancy-beyond-the-basics/print

  Will my fallopian tube be removed? — During surgery, it is sometimes possible to remove the ectopic pregnancy and repair the tube (called salpingostomy). […] In other cases, it is necessary to remove the fallopian tube (called salpingectomy). This may be required if there is uncontrolled bleeding, recurrent ectopic pregnancy in the same tube, a severely damaged tube, or a large tubal pregnancy. It may also be performed in people who have completed childbearing. If the remaining opposite tube is normal, the chance of a subsequent healthy pregnancy is good. […] In a small number of people treated surgically, embryonic tissue may still be present after surgery and cause the hCG level to remain elevated. A dose of methotrexate may be given if this occurs.

• #70 Ectopic pregnancy: Future fertility – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ectopic-pregnancy-signs-treatment-and-future-fertility

  Most women who experience ectopic pregnancy and treatment will achieve a successful pregnancy in the future, even if they’ve lost one fallopian tube as part of the therapy. There is a 10% risk of recurrence, which is why it’s important to work with your health care team when planning for a future pregnancy. Also, early documentation of an intrauterine gestational sac is of paramount importance. […] Studies that have looked at the difference in fertility after treatment of ectopic pregnancy showed that medical treatment of early ectopic pregnancies with medication, compared to surgical treatments sparing the fallopian tube, had no adverse fertility outcome. […] Also, women who were treated with surgery that spared the fallopian tubes and fallopian tube removal surgery had almost the same rate of pregnancy after treatment, given the other fallopian tube is healthy.

• #71 Ectopic pregnancy: Future fertility – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ectopic-pregnancy-signs-treatment-and-future-fertility

  In the event the other fallopian tube is damaged or absent, it’s better to try to spare the fallopian tube to maximize fertility potential, with the slight increased risk of recurrence. In the event of severe damage of the tube and need for its removal, the reproductive potential with no functional fallopian tubes will be severely compromised. If this is the case, fertility treatments like in vitro fertilization will be the only way to achieve pregnancy.

• #72 Ectopic Pregnancy Treatment, Surgery, & Recovery Time

  https://www.webmd.com/baby/treatment-for-ectopic-pregnancy

  Women used to stay in the hospital for a series of methotrexate injections. Now its 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. […] If methotrexate therapy doesnt work, surgery is the next step. […] Its 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. […] After surgery, your doctors will watch your hCG levels to make sure theyre going down and the pregnancy was removed properly. Some women also need a methotrexate injection so everything returns to normal.

• #73

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=acl8071

  You were given a medicine called methotrexate to treat your ectopic pregnancy. This was done to prevent dangerous problems. […] Treatment with methotrexate can be complex. It may involve a number of blood tests and doctor visits over the next several weeks. […] This treatment usually works well. But there is still a chance that you will need surgery. […] You should be able to have a normal pregnancy in the future. But you may have a higher risk for more ectopic pregnancies. […] Go to all follow-up appointments and tests. This helps your doctor make sure that your treatment is working.

• #74 Ectopic Pregnancy Causes, Symptoms, and Treatments

  https://www.upmc.com/services/womens-health/conditions/ectopic-pregnancy

  A ruptured ectopic pregnancy requires emergency surgery. This is typically with an abdominal incision in a procedure called a laparotomy. […] Many people who’ve had an ectopic pregnancy are able to have a successful pregnancy after treatment. But you should wait at least two to three months after medication or surgery before trying to get pregnant again.

• #75 Methotrexate for ectopic pregnancy | University of Iowa Health Care

  https://uihc.org/educational-resources/methotrexate-ectopic-pregnancy

  It is a medicine that can be used to treat an ectopic pregnancy. It stops certain cells from dividing by interfering with the folic acid in your body. […] Not every person with an ectopic pregnancy can be treated with methotrexate. There is a high chance of success if it can be used. This means you will not need surgery and the fallopian tube with the ectopic can stay in your body. […] About 9 out of 10 peoples tubes stay open after treatment. […] You will get your hCG level drawn every 7 days until your blood pregnancy test is negative. […] It is best to wait 3 months after methotrexate injection to try to get pregnant again. Talk with your provider about future pregnancy plans.

• #76 Ectopic pregnancy | The Royal Women’s Hospital

  https://www.thewomens.org.au/health-information/pregnancy-and-birth/pregnancy-problems/early-pregnancy-problems/ectopic-pregnancy

  An ectopic pregnancy must be treated to stop it from growing. If it is not treated it could lead to serious internal bleeding and occasionally even death. […] There are three options for treatment depending on the severity of your condition. They are: surgery, medication, wait and see. […] Surgery is recommended if the doctor believes you are bleeding internally or that you are likely to bleed internally. This decision is based on your symptoms, the examination findings and test results. […] If the doctors think that your risk of internal bleeding is very low, you may have the option of using medicine to stop the pregnancy growing. […] Treatment using medication should only be used if the ectopic pregnancy is very small and there is no sign that you have internal bleeding. […] If it seems likely that your ectopic pregnancy is miscarrying, the doctor may suggest that you wait and see. […] It is recommended that anyone who has had an ectopic pregnancy has an early ultrasound examination, at around five and a half to six weeks in all future pregnancies to check that the pregnancy is in the right place.

• #77

  https://www.healthxchange.sg/women/pregnancy/ectopic-pregnancy-treatment-future-pregnancies

  However, if the ectopic pregnancy is causing heavy internal bleeding or if the fallopian tube has ruptured, emergency surgery may be required to remove the tube (also known as a salpingectomy). Removal of the affected tube does not adversely affect future pregnancy rates provided that the other fallopian tube appears to be normal. […] If the ectopic pregnancy is treated without removing the fallopian tube, or if one tube is removed but the other one is in good condition, a woman can have a successful pregnancy in the future. […] However, a woman who has had an ectopic pregnancy is at a slightly higher risk of having another one. It is therefore important that she speak to her gynaecologist about her risk of ectopic pregnancy and the measures for early evaluation of her next pregnancy.

• #78 Diagnosis and treatment of ectopic pregnancy | British Columbia Medical Journal

  https://bcmj.org/articles/diagnosis-and-treatment-ectopic-pregnancy

  With improved laparoscopic instruments and techniques, minimally invasive surgery has become the gold standard for treating ectopic pregnancy and has mostly replaced laparotomy. Laparoscopic surgery offers a safer, faster, cheaper, and more esthetic option. […] Given that salpingotomy requires the surgeon to meticulously extract a small trophoblastic mass while preserving the fallopian tube, the method might be prone to trophoblastic tissue retention, which can necessitate a salpingectomy. […] Thus, for women with tubal pregnancy and a healthy contralateral tube, salpingectomy is a reasonable treatment option because it minimizes risk of ectopic mass persistence and does not seem to reduce future fertility. However, for women with contralateral tubal pathology or no contralateral tube, conservative treatment with salpingotomy should be considered if they wish to maintain the potential for natural conception. […] Patients who are asymptomatic and hemodynamically stable can be managed with either intramuscular methotrexate or laparoscopic surgery. The decision should be guided by patient characteristics, laboratory and radiological findings, and patient preference after discussion of the risks and benefits.

• #79 Ectopic Pregnancy: Signs, Treatment and SupportCloseleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowleft-arrowCloseReconfirm cookies choice

  https://www.tommys.org/baby-loss-support/ectopic-pregnancy-information-support

  The treatment you are offered will depend on different things, including: […] how many weeks pregnant you are, […] your symptoms, […] the results of any scans and blood tests, […] how much pain you are in, […] your pregnancy hormone levels and how they are changing, […] the options available at your local hospital, […] your own preference. […] In most cases, you can plan your treatment. Your healthcare team will discuss your options with you. They should explain the pros and cons of each option and answer any questions you might have. […] If your fallopian tube is ruptured, you will need emergency surgery. This is because of the risk of severe bleeding which could be life-threatening. […] You may be able to wait and see if the ectopic pregnancy ends by itself (expectant management). You are likely to have some vaginal bleeding after the ectopic pregnancy ends. Use pads or period pants rather than tampons or menstrual cups.

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