Ectopic Pregnancy Treatment: Medical Management with Methotrexate and Surgical Options like Salpingostomy and Salpingectomy

The ectopic pregnancy is a critical medical condition that occurs when a fertilized egg implants outside the uterine cavity, with the fallopian tube being the most common site. This type of pregnancy represents a potentially life-threatening emergency and is one of the leading causes of maternal mortality in the first trimester. Early identification and appropriate treatment are essential to prevent severe complications, such as fallopian tube rupture and hypovolemic shock.

Medical and Surgical Management of Ectopic Pregnancy

The treatment of ectopic pregnancy can be medical or surgical, depending on various factors, including β-hCG levels, the hemodynamic stability of the patient, and the risk of rupture. Medical management with methotrexate is a viable option for hemodynamically stable patients with relatively low β-hCG levels. This treatment involves the intramuscular administration of methotrexate, which inhibits the cellular growth of ectopic tissue. Studies have shown that methotrexate is effective in most cases, avoiding the need for invasive surgery and preserving future fertility [1](https://pubmed.ncbi.nlm.nih.gov/34918633).

In cases where medical treatment is not appropriate or has failed, surgical management is considered. Surgical options include salpingostomy and salpingectomy. Salpingostomy involves opening the fallopian tube to remove the ectopic tissue while preserving the tube for future conceptions. On the other hand, salpingectomy consists of the complete removal of the affected tube, which is necessary in cases of severe damage or rupture [2](https://pubmed.ncbi.nlm.nih.gov/32412215).

Monitoring β-hCG levels is crucial to evaluate the effectiveness of the treatment and ensure the complete resolution of the ectopic pregnancy. A progressive decline in β-hCG levels indicates successful treatment, while persistent or rising levels may suggest the need for further intervention [3](https://pubmed.ncbi.nlm.nih.gov/36999281).

Conclusions

The treatment of ectopic pregnancy requires an individualized approach, considering both the clinical characteristics of the patient and their future reproductive desires. The use of methotrexate offers an effective non-surgical option for many patients, while surgical interventions such as salpingostomy and salpingectomy remain essential in more complex cases. Continuous monitoring of β-hCG levels is fundamental to ensure treatment success and prevent complications. The choice of treatment should be guided by an experienced medical team, ensuring the best possible outcome for the patient's health and future fertility [4](https://pubmed.ncbi.nlm.nih.gov/29470343).

Referencias

• [1] Non-surgical management of tubal ectopic pregnancy: A systematic review and meta-analysis.
• [2] Ectopic Pregnancy: Diagnosis and Management.
• [3] Overview of ectopic pregnancy diagnosis, management, and innovation.
• [4] ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy.

Created 6/1/2025