Abortion Induction in Ectopic Pregnancy

Overview

An ectopic pregnancy occurs when a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tube. It is a life-threatening condition if untreated due to risk of tubal rupture and hemorrhage.

Unlike intrauterine pregnancies, abortion induction is not applicable; instead, treatment focuses on terminating the ectopic pregnancy either medically or surgically.

---

Treatment Options

1. Medical Management (Stable, Unruptured, Small Ectopic)

• Methotrexate (folic acid antagonist, inhibits trophoblastic growth)

  • Single-dose regimen:

    • Methotrexate 50 mg/m² IM once.

    • Monitor serum β-hCG on days 4 and 7; a drop ≥15% indicates success.

    • Repeat dose if inadequate decline.

  • Contraindications: hemodynamic instability, renal/hepatic impairment, breastfeeding, ruptured ectopic, large mass (>3.5 cm), fetal cardiac activity.

2. Surgical Management

• Laparoscopic salpingostomy: incision in tube, removal of products of conception; tube preserved.

• Laparoscopic salpingectomy: removal of affected tube (indicated if tube is ruptured, severely damaged, or patient has completed childbearing).

• Open laparotomy: required in unstable patients with active hemorrhage.

---

3. Supportive & Adjunct Therapy

• Analgesics:

  • Paracetamol 500–1000 mg PO q6h.

  • Avoid NSAIDs with methotrexate (reduce clearance).

• Rh immunoglobulin (Rho(D) Ig 50–300 mcg IM) for all Rh-negative women to prevent alloimmunization.

• IV fluids and blood transfusion if bleeding/rupture.

---

Key Notes

• Abortion induction drugs (mifepristone, misoprostol) are NOT used in ectopic pregnancy, since they act on intrauterine gestation.

• Methotrexate is the medical treatment of choice for suitable cases.

• Emergency surgery is required in ruptured ectopic or hemodynamically unstable patients.

• Long-term, women with ectopic pregnancy should be counseled about risk of recurrence (10–20%) and need for early ultrasound in future pregnancies.