Download Methotrexate for ectopic pregnancy (Ref 1170)

You should use contraception for three months to ensure you do not become pregnant.
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What can I do to prevent another ectopic pregnancy?
Patient Information
The overall possibility of having another ectopic pregnancy is about 1 in 10.
As an ectopic pregnancy is usually related to past damage to the fallopian tubes there is little that
can be done to prevent it happening again. However, if there are ongoing problems such as pelvic
adhesions from past surgery, pelvic inflammatory disease or pelvic infection, please discuss this with your
consultant.
If you have experienced an ectopic pregnancy, you should contact your GP as soon as you think you may
be pregnant. Usually your GP will refer you to the Early Pregnancy Assessment Unit where an early scan
will be performed to ensure the pregnancy is in the womb.
Author:Women and Children’s Services
Produced and designed by the Communications Team
Issue date Mar 2014 - Review date Mar 2017 - Expiry date *** 2018
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Treatment for ectopic pregnancy
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Who can I contact for further information?
What is an ectopic pregnancy?
Elsdon Ward
Tel: 01268 524900 ext 4528
Miscarriage Association
Tel: 01924 200 799
www.miscarriageassociation.org.uk
We are extremely sorry that your pregnancy is ectopic (developing outside the
womb). Please find below some information about ectopic pregnancy, and the
treatment your doctor thinks may be best for you.
We understand that this is a sad and distressing time. If you have any
questions or concerns, please speak to a nurse.
Gynaecology Emergency Unit (GEU)
Tel: 01268 524900 ext 8030
Ectopic Pregnancy Trust
Helpline: 020 7733 2653 (weekdays 10am – 4pm)
Email: [email protected]
www.ectopic.org.uk
Version 1
Ref no. PILCOM1170
This is a smokefree Trust.
Smoking is not allowed
in any of our hospital
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A pregnancy which develops outside of the uterus (womb) is called an ectopic
pregnancy. Every 1 in 80 pregnancies is ectopic - and can be life threatening.
Most ectopic pregnancies develop in one of the fallopian tubes (the tube that
carries the egg from the ovary to the uterus). On rare occasions the fertilised
egg can implant elsewhere, such as the ovary, cervix or abdominal cavity.
As the ectopic pregnancy grows, it causes pain and bleeding. If not treated
early enough, it may rupture the area in which it is growing, and cause severe
pain and bleeding.
What causes an ectopic pregnancy?
A fertilised egg normally spends 4-5 days travelling down the tube from the
ovary to the womb, where it should normally implant.
The Trust will not tolerate
aggression, intimidation or
violence
An ectopic pregnancy can occur when there is a problem with the movement of
the egg down the fallopian tube.
This can be caused by:
z Damage to the tube causing a blockage or narrowing. Conditions such
as appendicitis, pelvic infections or internal scarring from past surgical
procedures may cause permanent damage to the delicate structures in the
abdomen. This can delay the growing embryo getting to the uterus. If the
embryo becomes too large to pass through, it can become stuck and can
continue growing.
z A problem with the lining of the tube itself, preventing the fallopian tube from
effectively contracting and pushing the fertilised egg along.
z In some cases the cause of an ectopic pregnancy remains unknown.
Basildon University Hospital
Nethermayne
Basildon
Essex SS16 5NL
01268 524900
Minicom
01268 593190
How can an ectopic pregnancy be treated?
Ectopic pregnancies can be treated with medicine, or with surgery, depending
on individual circumstances.
Patient Advice and
Liaison Service (PALS)
01268 394440
E [email protected]
W www.basildonandthurrock.nhs.uk
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Your consultant has recommended that medical treatment for your ectopic pregnancy would be most suitable
for you. This is for the following reasons:
z Your condition is stable. You are not bleeding or experiencing severe pain, and you are currently in good
health.
z You have an early (less than eight weeks) un-ruptured ectopic pregnancy, which is less than 3cm in size,
and no foetal heart beats have been detected.
z A blood test has indicated a low level of the pregnancy hormone HCG (Human Chorionic Gonadotrophin).
What happens following the treatment?
It is usual to have some discomfort and pain initially. You may be admitted to hospital overnight, for general
observation.
Your progress and well-being will be monitored. This will include scans and blood tests to monitor the fall of the
HCG levels. The HCG levels can take between 2-4 weeks to fall to normal.
A few days after the injection, it is normal to start bleeding vaginally. This can last from a few days to six
weeks.
When you return home, please follow these instructions:
You will be offered an injection of a drug called Methotrexate
Treatment of ectopic pregnancy with Methotrexate is not appropriate if you have any of the following:
z An infection
z Kidney problems
z Severe anaemia or shortage of red blood cells
z Liver problems
z Peptic ulcer
z Ulcerative colitis
z HIV/AIDS
z Avoid any further pregnancy for three months by using a barrier method of contraception.
z Do not drink any alcohol or take recreational drugs.
z Avoid folic acid supplements.
z If you feel unwell and have a swollen abdomen, vaginal bleeding, shortness of breath or shoulder-tip pains
you should return to hospital immediately. This may be an indication of a ruptured ectopic pregnancy.
z Avoid aspirin or drugs such as ibuprofen for one week after treatment. Paracetamol is safe, however no
more than eight tablets in twenty four-hours.
If you have any questions or concerns, please contact the hospital for advice, on the telephone number at the
end of this information leaflet.
If you do not have any of the above, it is likely Methotrexate would be suitable for you.
How successful is the treatment?
What is Methotrexate?
The drug is not always effective, and an operation may be needed to remove the ectopic pregnancy.
Approximately 1 in 15 women need surgery following unsuccessful treatment.
Methotrexate is a drug that temporarily interferes with the growth of cells – particularly rapidly growing/dividing
cells such as those found in a developing embryo and placenta. The drug works by affecting the way in which
the cells use a vitamin called folate, which is essential to the growth of new cells.
Methotrexate does not lead to scarring or tissue damage around the fallopian tube, so it will not reduce your
chances of a successful pregnancy in the future.
The drug greatly reduces the need for an operation to treat an ectopic pregnancy, although 1 in 15 women
may still need surgery following treatment with Methotrexate.
Who is suitable for this treatment?
Not everybody is suitable for this treatment. Your consultant will speak with you and your partner and ensure
you have all the relevant information to make an informed choice and decision. They will discuss your
particular circumstances with you, and carry out a full diagnostic assessment.
You will need to have several blood tests taken, both before and after your treatment. If you have this
treatment, it is important that you agree to this. If you have any concerns or questions please do not hesitate to
ask the staff caring for you before you are given the drug.
How is Methotrexate given?
Your consultant will discuss this with you in more detail before you sign the consent form.
Are there any side effects or possible complications?
Some women may experience an increase in abdominal pain following the injection. This usually settles after
a couple of days. However, if the pain persists and is getting worse rather than improving, and you are feeling
generally unwell with dizziness and sickness, please contact the hospital for advice, by calling the number at
the end of this information leaflet.
Minor side effects can include:
z Nausea and vomiting
z Diarrhoea, flatulence
z Sensitivity to sunlight and mild headache
z Mouth ulcers
Methotrexate is given by a single injection, deep into a muscle. The dose will depend on your BMI (body mass
index - this is your weight and height). Before the drug is given, your liver and kidney function will be checked
and a full blood analysis will be carried out to ensure you are not anaemic.
z Anaemia
The drug will cause the growth and division of the cells to stop and shrink, and eventually the body will absorb
the remaining tissues naturally.
What will happen when I am at home?
z Some reversible hair thinning
You will need to return to the hospital regularly for follow-up care, including:
z Twice weekly HCG blood test (pregnancy hormone level).
z If your HCG levels are not falling you will need an ultrasound scan.
z Should the HCG level not fall significantly by the 7th day, your Consultant will discuss with you the possibility
of a further dose of Methotrexate or a surgical operation to remove the ectopic pregnancy.
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