If an ectopic pregnancy grows and causes the fallopian tube or other organ its growing in to rupture or bleed heavily, you might have more intense abdominal pain and bleeding; and also dizziness, light-headedness, pain in your shoulder or low blood pressure.
If your provider suspects an ectopic pregnancy, she’ll typically first measure the level of the pregnancy hormone hCG, or human chorionic gonadotropin, in your blood. The level will help your doctor figure out if it is a normal pregnancy, as well as if you’re pregnant at all, said Dr. Loretta Strachowski, M.D., a clinical professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. Your doctor may repeat the blood test later, to see if the hormone is rising at the expected rate of a normal pregnancy or not. In an early normal pregnancy, the hCG level is expected to double in 48 hours; if it’s an ectopic, it won’t rise at that rate.
If you’re pregnant, your provider will likely also do an ultrasound at the same time (or refer you to a lab or imaging center that does it) to see if your pregnancy is where it should be — in your uterus. Under normal circumstances, doctors can spot a pregnancy in the uterus when your hCG level has reached a certain threshold. “If we don’t see a pregnancy in the uterus at that level, then we become more concerned about an ectopic pregnancy,” said Dr. Diouf. You may need to come in again for more blood tests so your doctor can monitor your hCG level and do another ultrasound. “Diagnosis isn’t always made on the first visit,” explained Dr. Strachowski.
Because doctors can’t move an ectopic pregnancy to the correct location in your uterus, you’ll most likely need treatment to remove the pregnancy— either with medication or with surgery.
Medication. The less invasive option is medication, which your doctor will likely try if you’re stable and don’t have certain medical conditions, such as kidney or liver disease. Methotrexate, a chemotherapeutic drug, is most commonly used and is typically injected into your upper arm or buttocks in one dose (or possibly multiple doses). It “basically stops the ectopic pregnancy from growing,” explained Dr. Andrew Horne, M.B., Ch.B., a professor of gynecology and reproductive Science at the University of Edinburgh. Common side effects include mouth sores and skin inflammation.
Follow-up appointments — which are typically scheduled two or three days after treatment, and again a few days after that — will ensure your hCG level is dropping and that the drug is working. If it is, you’ll then have weekly visits until your provider has determined that the hormone level has diminished to the point where you’re no longer considered pregnant.
In 7 to 14 percent of cases, the ectopic pregnancy will still rupture the organ where it occurs, even with treatment. It’s also possible that the drug won’t completely resolve the ectopic pregnancy, and you might still end up needing surgery. For these reasons, it’s important to attend follow-up visits. If you can’t, methotrexate may not be the right option for you.