Ectopic pregnancies cannot continue to term, so removal of the developing pregnancy cells is necessary to save the life of the mother. In some cases, drugs may be used to destroy the cells instead. Treatment usually begins soon after the condition is diagnosed.

Most unruptured ectopic pregnancies are treated with methotrexate. Originally designed to treat cancer, this drug destroys ectopic pregnancy tissue, allowing it to be reabsorbed by the body. It may be given as a single shot or as a multi-dose regimen of shots or pills for several days. The treatment has a high success rate and minimizes scarring of the pelvic organs. However, the procedure may be unsuccessful, particularly when the ectopic pregnancy is large. Ultrasounds and human chorionic gonadotropin (a hormone produced by the placenta) levels are monitored after treatment to determine the drug’s effectiveness. When the treatment fails, it may be repeated or surgery may be used to terminate the pregnancy.

Methotrexate is most effective when used in the first six weeks of pregnancy. There are general protocols and guidelines established that determine if the use of methotrexate will be effective. For pregnancies that are further along, or pregnancies that have ruptured, surgery is often performed. Common surgical treatment options for ectopic pregnancy include:

• Salpingostomy. During this procedure, the fallopian tube is opened and the pregnancy tissue is removed. The fallopian tube is preserved, and heals on its own. In some cases, however, some of the pregnancy tissue may remain in the fallopian tube and continue to grow. According to the American Society for Reproductive Medicine (ASRM), this occurs in 5 to 15 percent of cases. When the procedure is unsuccessful, the pregnancy may be treated with methotrexate therapy or surgical removal of the tube.
  
  
• Partial salpingectomy. This procedure may be performed when the section of fallopian tube containing the ectopic pregnancy cannot be saved. During this procedure, the section of fallopian tube containing the ectopic pregnancy is surgically removed. When only a small portion of the tube is removed, it may be possible to rejoin the tube later using microsurgery.
  
  
• Total salpingectomy. During this procedure, the fallopian tube is completely removed. It may be used when the fallopian tube is extremely damaged or the ectopic pregnancy is large and requires rapid removal. It also may be the choice of treatment when future fertility is not an issue.
  
  
• Salpingo-oophorectomy. During this procedure, the fallopian tube and ovary are removed. This procedure will result in infertility for the woman. 
  
  
• Hysterectomy. During this procedure, the uterus is surgically removed. This procedure may be used to treat certain rare types of ectopic pregnancy, such as cervical pregnancies. Future pregnancies are not possible following a hysterectomy.
   

Surgery for ectopic pregnancy is often performed using a laparoscopic approach or through an abdominal incision. A laparoscopy is a procedure in which small incisions are made above the pubic area. A thin lighted tube (laparoscope) is inserted into the abdominal cavity through the incisions. The instrument allows the physician to view internal organs and insert other instruments as needed to remove the ectopic pregnancy and control bleeding. During a laparotomy, the surgeon uses a larger incision to open the abdomen. This procedure allows the surgeon to directly explore the internal organs, remove the ectopic pregnancy and repair surrounding tissue damage.  

Although laparoscopy is less invasive and yields similar results to that of laparotomy, not all surgeries can be performed with the technique. For example, ruptured ectopic pregnancies that cause internal bleeding may require a laparotomy because it is faster. In addition, some types of surgical procedures are too risky to perform laparoscopically. The decision may also be based on the surgeon’s experience using the techniques. 

A woman’s ability to become pregnant following surgery depends on the type of surgery performed. According to the American Academy of Family Physicians, the odds of having a successful pregnancy in the future are 60 percent when the fallopian tube has been spared. A woman who had one fallopian tube removed can have more than a 40 percent chance of having a successful pregnancy with the other tube. Hysterectomies result in the inability to become pregnant.

Internal bleeding caused by ruptured ectopic pregnancy may lead to shock, a life-threatening condition that occurs when the body does not receive enough blood flow. Immediate treatment for shock may involve keeping the patient warm, elevating her legs and administering oxygen. Treatment with intravenous fluids (into a vein), and in some cases a blood transfusion, is also required as soon as possible. Laparotomy may be required to stop the immediate loss of blood.   

Following treatment, there is an increased risk of infertility and subsequent ectopic pregnancy. According to the National Institutes of Health (NIH), infertility occurs in 10 to 15 percent of women who have experienced an ectopic pregnancy and subsequent ectopic pregnancies occur in about 10 to 20 percent of cases. In addition, some women who achieve pregnancy after ectopic pregnancy experience a miscarriage during the first trimester. The NIH estimates that approximately 85 percent of women who have experienced an ectopic pregnancy are able to achieve a normal pregnancy in the future.

Since the risk of infertility and subsequent ectopic pregnancies is high, women who have experienced an ectopic pregnancy should discuss plans of pregnancy with their obstetrician-gynecologist (ObGyn) before becoming pregnant again. Patients may be encouraged to wait three to six months after treatment before attempting another pregnancy.

For women who have had multiple ectopic pregnancies, in vitro fertilization (IVF) may be recommended. During this procedure, a woman’s egg is combined with sperm outside the body. The resulting embryo is then implanted into the uterus. According to the ASRM, there is only about a 5 percent chance of a tubal pregnancy with IVF.