Download Methotrexate use in an Ectopic Pregnancy

Women’s Health Service
Methotrexate Use in an Ectopic Pregnancy
Information for patients
What is an ectopic pregnancy?
An ectopic pregnancy is a pregnancy that is
growing outside of the uterus (womb). It is
a pregnancy, which cannot survive but poses
significant risk to the health of the mother because
it can rupture - causing considerable bleeding and
pain.
How are ectopic pregnancies
treated?
Until recently all ectopic pregnancies were treated
by having an operation to remove the pregnancy.
This could involve loss or damage to the fallopian
tube in which the ectopic pregnancy was growing.
Today some ectopic pregnancies can be managed
using drug therapy and therefore a general
anaesthetic and surgery can be avoided.
What is Methotrexate?
Methotrexate is a drug, which is being increasingly
used in the management of ectopic pregnancies.
Within the Women’s Health Service it is commonly
administered as a single injection into the
buttocks. Very occasionally women require a
second dose.
Is Methotrexate safe?
Studies have shown that following the
administration of Methotrexate there is no
increased risk of miscarriage or congenital
abnormalities in subsequent pregnancies.
Once the Methotrexate has been administered you
may experience some abdominal discomfort which
is due to the normal action of Methotrexate on the
ectopic pregnancy. This abdominal discomfort can
be relieved by taking paracetamol or other pain
killers.
There is a risk that an ectopic pregnancy could
rupture and cause internal bleeding even if
Methotrexate has been given, therefore you must
seek medical care if you experience any of the
following symptoms:

An increased amount of abdominal pain

You are feeling generally unwell

Have dizziness or faintness

Nausea and vomiting or

Shoulder-tip pain
Our emergency phone numbers are listed on the
reverse of this brochure.
If your symptoms come on sudden or are severe it
is appropriate to call an ambulance.
What are the advantages of
Methotrexate?
If Methotrexate is successful surgery can be
avoided. This means:

No need for a general anaesthetic

No surgery on the fallopian tubes - so there
is a better chance of normal fertility
What are the disadvantages of
Methotrexate?

A small risk of side-effects

A small risk of subsequently needing surgery
(5 – 10%)

More follow-up care is required (on average
5 weeks).
Issued August 2012 / Review August 2015 / ID W&CHD GA PIB-46 Vn 2
What side-effects might I expect
following the Methotrexate
injection?
interfere with the action of the Methotrexate
and may make it less effective.

Avoid vitamin preparations containing folic
acid for at least 3 months as these may also
interfere with the action of Methotrexate. If
another pregnancy is contemplated then folic
acid should be taken for at least 2 months
prior to conception.

Avoid excessive sun exposure while
treatment is in progress as Methotrexate
sensitises your skin to sunlight.
Overall the side-effects are rare but you may
experience:

Mouth ulcers

Conjunctivitis

Diarrhoea and vomiting

Skin rashes

A dry cough

Abnormal liver function tests

Abdominal pain
After receiving your Methotrexate
injection:

Preparing for the administration of
Methotrexate:
If you decide to have Methotrexate you must
have blood tests taken before the injection is
administered. The blood tests we need to perform
include:

A Full Blood Count

Kidney Function Tests (because Methotrexate
is removed from the body via the kidneys)

Liver Function Tests

ßhCG (hormone level measured during early
pregnancy)
Height and weight:
We need to record your height and weight, as this
will help us determine the amount of Methotrexate
that you will need.
You must return for further blood tests after
the Methotrexate has been given. This is to
ensure that the drug is working properly and
that your ßhCG level is falling appropriately.
The schedule of blood tests is outlined
below:
Day 1 Full blood count, kidney function tests, liver
function tests, and ßhCG.
Methotrexate injection is administered
Day 7 Full blood count, kidney function tests, liver
function tests, and ßhCG.

If your ßhCG level has not fallen sufficiently
after one week you may need another
injection of Methotrexate.

If the ßhCG fall is satisfactory you will only
require weekly blood tests until the ßhCG
returns to normal.
Emergency phone numbers:
Acute Assessment – 04 8060 740 and
You will be advised to:

Avoid sexual intercourse or use a reliable
form of contraception until the ectopic
pregnancy has resolved and this may take up
to 3 months. If a further pregnancy occurs
before the ectopic pregnancy has completely
resolved then there is a significant risk of
that fetus having a congenital abnormality.

Avoid breastfeeding until the ectopic
pregnancy has resolved.

Avoid alcohol for 3 months – as this will
Gynaecology inpatient ward – 04 8060 880