Methotrexate for Ectopic Pregnancy

An ectopic pregnancy means a fetus is growing outside of the uterus, most often in the fallopian tube. The fetus can't survive in the fallopian tube. There's no way to save the pregnancy 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 pregnant person.

Methotrexate is a medicine given for ectopic pregnancy. It stops the fetus from growing. The pregnant person's body then usually absorbs the fetal tissue. Methotrexate is an alternative to surgery. The advantage of this treatment is that it prevents 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 it removes the fallopian tube itself. If surgery removes the fetus only, you may have scarring of the fallopian tube and infertility.

Methotrexate is given as a shot (injection). After treatment, you may have mild belly (abdominal) pain or cramping. Some women also have nausea and vomiting, diarrhea, or severe tiredness (fatigue).

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

You'll have your blood taken a few 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 0.

Most women need only 1 injection. But you may need more than 1, depending on your situation.

Home care

These guidelines will help you care for yourself at home:

  • You may go back to 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 wash out the inside of your vagina (douche).

  • Don’t use alcohol, any vitamins with folic acid (vitamin B-9), or penicillin until your HCG level is back to 0.

  • Don’t take aspirin or other anti-inflammatory medicines, such as ibuprofen and naproxen for 1 week after methotrexate treatment, or until your 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 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 get medical care

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

  • Pain in your lower belly 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 advised by your provider

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