There are 3 options to managing an ectopic pregnancy:
1- Conservative: If the ectopic pregnancy is spontaneously getting smaller and the levels of BHCG (a hormone produced from the pregnancy) are dropping substantially, a wait and monitor approach can be taken. Close monitoring with regular check-ups, follow up BHCG levels and Ultrasound scans are warranted. The patient should be medically stable and willing to comply with the follow up plan. Easy access to a hospital is important.
2- Medical: This involves administration of a medication called Methotrexate. The criteria for this management approach are: a medically stable patient, willing and able to comply with follow-up as well as residing close to a hospital, have a BhCG concentration ≤5000 mIU/mL, and no fetal cardiac activity. The size of the ectopic pregnancy matters and it is preferrable to be < 5cm. Follow-up entails regular check-ups with serial BHCG levels to ensure they are falling.
3- Surgical: key-hole surgery is an option. A patient can choose to have this surgery electively and this would involve in most cases the removal of the tube with the ectopic in its entirety. It would be recommended if the patient is unsuitable for medical treatment, or if the methotrexate was unsuccessful.
A patient would need emergency laparoscopic surgery if there is evidence of rupture of the tube and ectopic pregnancy. This presents with severe pain, dizziness, abdominal bloating, shoulder tip pain, and an ultrasound scan revealing intra-abdominal bleeding. Urgent presentation to the nearest Emergency Department is paramount and should be via ambulance.
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