Treatment of Ectopic Pregnancy with Methotrexate

What is an ectopic pregnancy?

Ectopic (tubal) pregnancies are conceptions which are located outside of the uterus, usually in the fallopian tube. It has been shown that a small percentage of ectopic pregnancies will resolve on their own.

Traditionally, ectopic pregnancies were surgically removed once the diagnosis of ectopic pregnancy was made, due to risk of rupture. Treatment risks included those of anesthesia, infection, blood loss, a hospitalization, and prolonged recovery time at home.

Recently, these techniques have been applied via Laparoscopy, decreasing surgical morbidity, reducing the hospital stay and recovery time at home, but still exposing the patient to the risk of anesthesia.

How does Methotrexate work?

The non-surgical alternative is to treat you with a medication called methotrexate. Methotrexate has shown significant promise as an alternative to surgery with an overall success rate of 95% and subsequent tubal patency of 50-80%, which is comparable to surgical treatment.

Technically, when used at much higher doses and for longer periods of time, methotrexate is an approved chemotherapy drug used to treat cancer, psoriasis, and rheumatoid arthritis. It interferes with cell growth and division, thus reducing the size of the ectopic.

You may need to receive a second dose of methotrexate if the tubal pregnancy continues to grow, or in the HCG level (which we will follow closely in your blood) doesn't decrease in the expected time interval. Some women who receive Methotrexate may require subsequent surgery if the pregnancy continues to grow, or if the tubal pregnancy ruptures causing bleeding into the abdomen. This happens less than 5 % of the time.

Treatment Benefits

The benefit of your using Methotrexate is that you will avoid having surgery, with the risks of anesthesia, and you won't be hospitalized.

Side Effects

It is extremely unlikely that you will have any side effects from it, but in rare cases, it can cause stomatitis (a rash and/or ulceration of the month or tongue), nausea, abdominal pain, a decrease in white blood cells (the part of the body that fights infection), or elevated liver enzymes. Most of these side effects are reversible by discontinuing therapy.

Risks

You will have an increased risk of having another tubal (ectopic) pregnancy whether you are treated with surgery or Methotrexate. At the present time, we are unaware of any evidence to indicate that Methotrexate will cause you any long-term problems or cause harm to any future pregnancies you may have.