To be a candidate for methotrexate treatment, a woman needs to be in stable condition with no evidence of internal bleeding or severe pain. She also needs to maintain communication with her physician during the treatment protocol and be able to return for follow-up blood tests after treatment.
Methotrexate is a drug that was initially used to treat certain types of cancers, some of which are derived from placental tissue. It is very effective in destroying ectopic pregnancy tissue and allowing it to be reabsorbed by the body. It can also destroy normal pregnancy tissue.
Therefore, it is not an option for women with a heterotopic pregnancy. Methotrexate is given as a single intramuscular shot or as a series of shots over several days.
Most early ectopic pregnancies can be successfully treated with methotrexate. This often leaves the tube open. Success is based largely on the size of the ectopic pregnancy seen on the ultrasound exam and the level of hCG found on the blood test. These women may be considered candidates for multiple-dose methotrexate regimens or surgical treatment.
If methotrexate is successful, hCG levels should decrease to zero over the next 2 to 6 weeks. If the hCG levels do not fall, methotrexate treatment may be repeated or the pregnancy may be removed surgically.
There are no known long-term side effects from use of methotrexate. The short-term side effects are few. The drug can cause temporary ulcers in the mouth and other gastrointestinal areas and can cause temporary changes in liver function. Rare complications include pneumonia. Decreased platelet production, another rare complication, can cause bleeding within 2 weeks after the injection.
Any woman with changes in liver blood tests, anemia low blood counts , or platelet disorders cannot take methotrexate. A woman may have some abdominal pain for a few days due to the resorption of the ectopic pregnancy. Any severe pain needs to be reported to her physician. Women should limit sun exposure during treatment, as methotrexate can cause sensitivity to sunlight and sunburn may occur.
When being treated with methotrexate, women should not drink alcohol or take vitamins containing folic acid folate. Until the last 20 years, ectopic pregnancies usually were treated by total salpingectomy removal of the entire tube [Fig. Today, most surgeries for ectopic pregnancies are performed by laparoscopy. Laparotomy usually is reserved for those ectopic pregnancies that have ruptured, causing severe internal bleeding, or when there is extensive scar tissue inside the abdomen and pelvis.
If the ectopic pregnancy is diagnosed early, before the tube ruptures, a laparoscopic salpingostomy may be performed. In this procedure, the fallopian tube is opened and the pregnancy tissue is removed while leaving the tube in place Fig. The tube then heals on its own. This may be treated by additional surgery to remove the tube or by using methotrexate therapy.
A partial salpingectomy sometimes called a segmental resection, to remove a middle segment of the tube [Fig. If only a small portion of the tube is removed, the tube may be rejoined later using microsurgery. If the fallopian tube is extremely damaged, the ectopic pregnancy is large, or the woman is bleeding excessively, a total salpingectomy is performed.
In rare cases when the ectopic pregnancy involves the ovary, a portion of the ovary or the entire ovary may be removed. Women usually remained in the hospital 2 to 5 days following surgery and returned to work in 2 to 6 weeks, depending on the level of physical activity required. Following laparoscopy, women generally are able to go home the day of surgery and recover more quickly, returning to full activities in 3 to 7 days.
Despite the advantages of laparoscopy, not all surgeries for ectopic pregnancy can be done with this technique. Emergency situations with extensive internal bleeding or large amounts of intra-abdominal adhesions may require immediate laparotomy. Some types of operations also may be too risky to perform laparoscopically, while in others it is not clear that laparoscopy yields results as good as those by laparotomy.
When considering a pelvic operation, the patient and doctor should discuss the pros and cons of performing a laparotomy versus a laparoscopy, including the surgical risks. A woman who has had an ectopic pregnancy has a lower chance of becoming pregnant again.
In addition, her chance of having another ectopic pregnancy is higher. Fortunately, over half of women who experience an ectopic pregnancy will have a healthy baby sometime in the future.
Women with 2 or more ectopic pregnancies may have tubal disease and may want to consider IVF. Ectopic pregnancy is a physically and emotionally traumatic experience.
In addition to experiencing the loss of a pregnancy, women may fear the loss of future fertility. Feelings of grief and loss are normal. Sadness, anger, self-blame, guilt, and depression are part of the grieving process and need to be acknowledged and expressed.
Time is necessary for both physical and emotional healing before attempting another pregnancy. For more information on these support groups, consult the Resources section below. Ectopic pregnancy refers to any pregnancy implanted outside the uterus, usually in the fallopian tube.
Modern surgical and medical treatments frequently allow women to avoid extensive surgery and preserve their fallopian tube. Although the risk of having another ectopic pregnancy is increased, many women will successfully conceive and have children in the future, either naturally or with the aid of an assisted reproductive technology such as IVF.
Abdominal pregnancy. An ectopic extrauterine pregnancy that has implanted on structures in the abdomen other than the uterus, fallopian tubes, or ovaries. It usually implants on tissue in the abdomen known as the omentum. A condition where the appendix a tubular structure attached to the large colon becomes infected and inflamed and can be associated with the formation of adhesions in the proximity of the fallopian tube.
The lower narrow end of the uterus that connects the uterus to the vagina. Diethylstilbestrol DES. A synthetic hormone formerly given during pregnancy to prevent miscarriage. Women born from treated pregnancies can have abnormalities of the reproductive system, including an increased risk of ectopic pregnancy. An outpatient surgical procedure during which the cervix is dilated and the lining of the uterus is scraped out. The tissue is often microscopically examined for the presence of abnormality or pregnancy tissue.
Ectopic pregnancy. A pregnancy that implants outside of the uterus, usually in the fallopian tube. The tube may rupture or bleed as the pregnancy grows and present a serious medical situation.
The earliest stage of human development arising after the union of the sperm and egg fertilization. A condition where patches of endometrial-like tissue develop outside the uterine cavity in abnormal locations such as the ovaries, fallopian tubes, and abdominal cavity.
Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Important Phone Numbers. When should you call for help? Where can you learn more? Top of the page. Your Care Instructions An ectopic pregnancy occurs when a fertilized egg grows outside of the uterus.
How can you care for yourself at home? After your treatment, you may have vaginal bleeding that's similar to a period. It may last for up to a week. Use pads instead of tampons. You may use tampons during your next period. It should start in 3 to 6 weeks. Do not have sex until after the bleeding stops. If you are treated with methotrexate: Your doctor will let you know if you can take over-the-counter pain medicine, such as acetaminophen Tylenol , ibuprofen Advil, Motrin , or naproxen Aleve.
Read and follow all instructions on the label. Do not take two or more pain medicines at the same time unless the doctor told you to. Many pain medicines have acetaminophen, which is Tylenol.
Too much acetaminophen Tylenol can be harmful. Do not drink alcohol. Click here to find the answers. Professionals Leaflets Guidance Reports Collaborations. Donate Now. You may have questions regarding bleeding and periods post an ectopic pregnancy, we hope the following information helps to answer them. If you still have questions after reading through please feel free to contact us or leave feedback in the green box at the bottom of the page.
Please remember that online medical information is no substitute for expert medical care from your own healthcare team. Get in touch If you or someone you know needs support with an ectopic pregnancy, please feel free to contact us. Type your question:. How long will the bleeding last? Should my bleeding have all these clots in it? I haven't bled following my treatment with methotrexate. When can I expect a period after my ectopic and will it be painful? Will my period cycle return to normal after my ectopic?
Other pages you might find helpful. Returning to "normal". Following up with the hospital. Did you find this useful? Yes, thank you. No, not really. Get help.
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