Medical Treatment
With early diagnosis of an ectopic pregnancy, medical (non-surgical) treatment often is possible with the drug methotrexate. To be a candidate
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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. Women with large ectopic pregnancies or rapidly rising and/or high levels of hCG (>10,000 IU/L) are less likely to respond to single-dose methotrexate therapy. 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.