Ectopic pregnancy: medical or surgical treatment
If the ectopic pregnancy has been reliably diagnosed and there is no pain, treatment with medication can also be carried out. Methotrexate is injected – which inhibits fast-growing tissue. The pregnancy dies with this medication and is broken down by the body. Close medical supervision is essential with this therapy. If this is not guaranteed, the therapy cannot be carried out. There are further criteria that must be met for the use of methotrexate:
- The fruit sack is smaller than four centimeters.
- Liver and kidneys function normally.
- The lungs are healthy.
- You are not breastfeeding.
- The blood values are normal.
- The wall of the fallopian tube is still intact.
After administration of the medication, regular checks are carried out with ultrasound and blood tests to ensure that the effect lasts and the pregnancy hormone decreases. Depending on the course of the disease, the administration of the medication can be repeated.
Operation for an ectopic pregnancy
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.
A camera with light is inserted via the navel and working instruments can be inserted via two further small incisions in the lower abdomen (so-called keyhole technique). The advantage of this so-called “minimally invasive” method is the shorter operation time with less blood loss and the smaller wounds, which enable faster healing and less soreness after the procedure.
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. If there have been previous ectopic pregnancies in the same fallopian tube or if there is no desire to have children, a salpingectomy can also be performed. In the case of salpingotomy, where the fallopian tube is left in place, it can happen in rare cases, however, that pregnancy tissue remains in the fallopian tube, which is noticeable by a lack of a drop in the pregnancy hormone in the blood. Metothrexate can then be administered in these cases. After salpingotomy, the pregnancy hormone in the blood must therefore be checked regularly until the level falls below the detectable limit.