Methotrexate for Ectopic Pregnancy

An ectopic pregnancy means the baby is growing in the outside of the uterus, most commonly in the fallopian tube. The fetus can't survive in the fallopian tube. There is no way to save the fetus in this situation. An ectopic pregnancy is a very serious condition. It can lead to severe internal bleeding as the growing fetus tears the fallopian tube. It can also threaten the life of the mother.

Methotrexate is a medicine given  for ectopic pregnancy. The medicine stops the fetus from growing. The mother's body then usually absorbs the fetal tissue. Methotrexate is an alternative to surgery. The advantage of this treatment is that it avoids the risks of surgery. These risks include bleeding, infection, injury to the body, and the side effects of anesthesia. The surgery removes the fetus from the fallopian tube or removes the fallopian tube itself. If surgery removes the fetus only, you may have scarring of the fallopian tube and infertility.

Methotrexate is given by injection. After treatment, you may have mild abdominal pain or cramping. Some women also have nausea and vomiting, diarrhea, or fatigue.

There are some cases when you can't use methotrexate. Be sure to tell your healthcare provider if you have other health conditions, especially peptic ulcers, pulmonary diseases, kidney disease, or liver disease.

You will have your blood taken several times in the weeks after the methotrexate injection. This is to make sure your pregnancy hormone level (HCG) is getting lower. This shows that the pregnancy has ended and the fetus is no longer growing. It may take about 4 weeks for your level to drop to zero.

Most women need only one injection. But you may need more than one, depending on your situation.

Home care

These guidelines will help you care for yourself at home:

  • You may resume normal activities if you don’t have heavy bleeding or pain.

  • To prevent infection during treatment and until the bleeding completely stops:

    • Don’t have sex for as long as your healthcare provider tells you.

    • Use sanitary pads instead of tampons.

    • Don’t douche.

  • Don’t use alcohol, any vitamins with folic acid (vitamin B-9), or penicillin until your HCG level is back to zero.

  • Don’t take aspirin or other anti-inflammatory medicines such as ibuprofen and naproxen for 1 week after methotrexate treatment or until your healthcare provider says it’s OK.

  • You may use acetaminophen to control pain, unless another pain-relieving medicine was prescribed. Talk with your provider before using these medicines if you have chronic liver disease.

  • Don't eat gas-producing foods such as beans and cabbage. These might make abdominal pain worse.

  • Stay out of the sun during treatment. Methotrexate may cause you to be sensitive to the sun.

  • Use birth control for 4 to 6 months after treatment or as long as your healthcare provider tells you to.

  • If you feel sadness or grief after pregnancy loss, it may help to talk about your feelings with family and friends, or with a counselor.

Follow-up care

Follow up with your healthcare provider, or as advised for repeat HCG blood testing.

When to seek medical advice

Call your healthcare provider right away if any of these occur:

  • Pain in your lower abdomen that gets worse

  • Heavy vaginal bleeding (soaking 1 new pad an hour over 3 hours)

  • Repeated vomiting or unable to keep down fluids because of nausea

  • Dizziness, weakness, or fainting

  • Fever of 100.4°F (38°C) or higher, or as directed by your healthcare provider

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