The mainstay of treatment for ectopic pregnancy has been surgery. To day, some ectopic pregnancies can be treated with medications that cause the embryo to stop growing and reabsorb into the maternal tissues. Ectopic pregnancies sometimes cure themselves, when the embryo becomes reabsorbed without medication. On occasion an ectopic pregnancy can be watched for a short period of time to see if it can resolve. This is called expectant management, and requires careful monitoring.

The following discussion of treatment for ectopic pregnancy assumes the pregnancy is in the fallopian tube, as this is most common, accounting for about 95 percent of all ectopic pregnancies. When the pregnancy is located in another organ, the treatment will vary somewhat.

The choice of treatment for an ectopic pregnancy will depend on how early in the pregnancy the ectopic is found and how large it is. It will depend on where in the tube the pregnancy is found-whether it is in the part that attaches near the uterus or the part distant from the uterus, near the open end of the tube. Treatment will depend on whether or not the ectopic pregnancy has ruptured out of the tube. It will depend on the extent of bleeding the woman has experienced and whether she is in shock. It will depend on the experience and preference of the physician providing the care. Treatment may depend somewhat on whether the woman desires future fertility, although preservation of her life must be the main consideration.

Surgical treatments for ectopic pregnancy may be performed via a laparoscopy or laparotomy. Oxygen, intravenous fluids, and possibly blood transfusion may be components of needed care.

Salpingectomy and salpingostomy are the surgical procedures used to actually remove the ectopic pregnancy. Salpingectomy means removal of the fallopian tube. Salpingostomy (or salpingotomy) means making an incision in the tube through which the pregnancy is removed. Part of the tube may be removed, with repair accomplished at a later date, after healing has taken place. Salpingostomy is called "conservative" treatment as it saves the tube.

The method of surgical removal depends on the extent of damage to the tube. It also may depend on whether the opposite tube appears normal or diseased and whether the woman wishes to have future pregnancies. A procedure in which the pregnancy was "milked" out of the tube used to be performed if the pregnancy had not ruptured, but recent findings indicate that this procedure results in a very high rate of repeat ectopic pregnancy.

If the other tube appears diseased, then surgery that spares the tube containing the ectopic will increase the likelihood that the woman will be able to get pregnant again and carry the pregnancy. After such conservative surgery, however, there is also a higher risk of a repeat ectopic pregnancy. If the other tube appears normal, then future fertility is likely to be the same whether a salpingectomy or salpingostomy is performed.

Since 1985, medications have provided an alternative to surgery for treatment of ectopic pregnancy. Several medications have been used, most frequently methotrexate-an anticancer drug. Methotrexate works by inhibiting growth of the embryonic cells, in much the same way as it stops growth of cancer cells.

Methotrexate can be used only when the ectopic pregnancy has not ruptured and when the diagnosis was made without surgery. The woman must not show any noticeable signs of blood loss. Her blood values, such as hematocrit and hemoglobin, must be normal and stable. The mass in the tube cannot be larger than three to four centimeters (less than two inches). The woman must be able and willing to return for follow-up care. She must not have medical reasons that make methotrexate dangerous or contraindicated. Such contraindications include breast feeding; diseases of the blood, liver, kidney, lung, or immune system; alcoholism; peptic ulcer disease; or a known allergy to methotrexate.