Methotrexate for ectopic pregnancy dose calculation,how to conceive a female child examination,pregnant ob gyn visits,how do know if i can get pregnant - PDF Review

The term  ‘medical management’, when used in relation to ectopic pregnancy, means using a drug called methotrexate.
Methotrexate is a powerful drug which works by interfering, in a temporary way, with the processing in the body of an essential vitamin called folate.
The treatment is given by means of an injection, usually given by a single injection into the muscle. You should stop taking any vitamins, minerals or other medicines unless you have been told by the doctors treating you to continue with them.
Most people take time off from work initially and do not return to work for around 2 weeks while the treatment begins to work. In the first week it is important to avoid pain killers which fall into the NSAID group such as ibuprofen. The main risk associated with treating you medically is that the medicine will not work and the cells of the ectopic pregnancy might continue to divide, which could result in there still being a need for surgery.
Your doctors will be able to tell if your pregnancy isn’t resolving, as this will be shown in the results of the regular blood tests. Your hospital should have given you a number to contact for health advice if you feel that anything is changing, or you will have been told to report to the accident and emergency department.
All women who suffer ectopic pregnancy are advised to avoid becoming pregnant for at least two proper period cycles, which is normally about three months.
Until your doctors are confident that your pregnancy is ended it can be difficult to think about the future or for your emotions to surface properly. Methotrexate is most effective in the earlier stages of pregnancy, usually when the hCG level is below 3000. In an ectopic, there is often a pregnancy sac, but most often a foetus or baby as we would know it, is not developing.
My hospital will not offer methotrexate, although I think I should be eligible for that treatment. The decision ultimately lies with your medical team within the health authority you are under, but there is never any harm in making it clear what your wishes are and asking to be assessed by someone who does use methotrexate. If you need any help with this you need to contact PALS at the hospital where you are being treated. The action of methotrexate is not instantaneous – it takes a few days for the cells of the pregnancy to stop dividing . When we use methotrexate as a treatment for ectopic pregnancy, we expect to see a rise in the hCG level on day four after it has been given because we know the cells will have continued to divide for two or three days after it was given. The way methotrexate works is to deplete the body of the essential vitamin it needs to replicate cells. You really do need to take things gently in the first couple of weeks after treatment with methotrexate.
Folacin or folic acid in the form we take it in by our diets and supplements is a B vitamin and it is one of the vitamins that give us energy. The tissue can shrink and be reabsorbed by the body – this happens because it is our DNA and our cellular material in the first place and so the body just reuses its resources.
The bleeding that follows an ectopic pregnancy treated with methotrexate can be very heavy and clotty and result in the passing of what we call a decidual cast.
It is important is that anyone treated with Methotrexate avoids alcohol, NSAID drugs such as Ibuprofen and folic acid (this would include multivitamin complexes where there is a folic acid element) while the treatment is working. The reason that drinking alcohol is advised against is because methotrexate is metabolised in the liver in a similar way to alcohol. It is not uncommon for women who have been treated with methotrexate not to have any bleeding.
The advice given to mothers who are taking regular oral doses of methotrexate, not for an ectopic pregnancy but to treat another entirely different condition, is NOT to breastfeed during their treatment. HOWEVER, the advice for women who have had Methotrexate for the treatment of ectopic pregnancy is different. If your baby is less than a year old and if breast milk is the sole source of nutrition, we advise avoiding breast feeding for at least four weeks following treatment with methotrexate. In ectopic pregnancy, when one dose of methotrexate has been given, the risk is not the accumulation in neonatal tissues.
To see the Ectopic Pregnancy Trust Frequently Asked Questions about recovery from ectopic pregnancy, please follow this link. Locally Healthy, Digital Life Sciences, Waterloo House, 20 Waterloo Street, Birmingham B2 5TBImportant NoticeThe information provided on this website including medical information, is for use as information or for educational purposes only and is not a substitute for professional medical care by a qualified doctor or other qualified healthcare professionals.


A few days after the injection, it is usual to begin to bleed and this bleeding can last between a few days and up to 6 weeks. The preferred painkiller is paracetamol and you should refrain from drinking alcohol until the levels have fallen to a non-pregnant state. Around 15% of women who are treated with methotrexate initially go on to need medical or surgical treatment.
If you have not been told what to do and need to speak to someone ring the hospital department which is treating you or NHS Direct on 0845 46 47. Being managed medically can be a worrying time for any woman, and until your hCG levels drop, you may still feel pregnant. This can feel frustrating but the outcome is often very successful and it is worth persevering with the wait involved for the hCG levels to drop, and the repeated blood tests, until that happens. It is the rapid division of these specialised trophoblast cells which causes hCG to be produced. More importantly we want to see a drop of at least 15% on day seven and if not, this is when the doctors will consider a second dose or surgery. It should first be said that in ectopic pregnancy, because the egg has implanted in the wrong place, it is unable to source a good blood supply. Cramping abdominal pain is the most common side effect, and it usually occurs during the first 2 to 3 days of treatment. Therefore if the liver is very stretched through having to work too hard, it can cause you to feel very ill, especially during the first couple of weeks after your treatment.
In this case, methotrexate is usually given as a one off dose (or occasionally two doses) by injection into a large muscle. If your child has been weaned, and is taking a balanced diet of mixed foods with an occasional breast feed for comfort, you may choose to start feeding again sooner than this.
The risk is that the milk will be of poor quality and of little nutritional use, due to the missing essential vitamins on which the body depends to support the division of rapidly dividing cells. We do not warrant that any information included within this website will meet your health or medical requirements. The drug stops the pregnancy developing any further and the pregnancy is gradually reabsorbed. This means that you will have to attend the hospital regularly for blood tests until the tests are negative.
It is usual to have some discomfort and pain initially but as long as this is not severe and you are feeling well this is nothing to worry about. Doctors can tell if the specialised cells of a pregnancy that produce the hCG hormone are dividing because the hCG level will rise and not fall. A description of the signs of a deteriorating ectopic pregnancy, which include severely increased pain levels, vaginal bleeding, shortness of breath and pain in the tip of the shoulder, among others, which will alert you to the fact that you need to be reassessed, can be located here. This is because the methotrexate may have reduced the level of folate in your body which is needed to ensure a baby develops healthily. Being worried about whether the pregnancy is resolving is quite normal and that is why your doctors are checking your hCG levels.
However, in cornual ectopic pregnancy it is not unusual to try to treat with higher levels.
Trophoblast cells are the invading cells of the pregnancy and those that form the afterbirth or placenta.
As a result the ‘trophoblasts’ are trying to ‘burrow’ in to the walls of the structure the egg is stuck in and all energy and growth is occurring there. Alternatively, it can appear to block the tube and over weeks, months or sometimes years ‘shrink’ to allow the tube some patency at a later date. The lining of the uterus when we are pregnant, other than that which is taken up by the placenta, is called the decidua. Because abdominal pain is also a sign of a ruptured ectopic pregnancy, report any abdominal pain to your health professional. However, because the drug may accumulate in neonatal tissues, breast feeding is not recommended in long-term use of methotrexate. It antagonises folic acid (vitamin B9) and causes it to be excreted, depleting the body of this essential vitamin. This is very significant in small children as they are growing and relying on this crucial process.
Methotrexate is also used to try and control other unwanted rapidly dividing cells, such as those which cause the condition rheumatoid arthritis, psoriasis, and some specialised cancerous lesions.


Before the injection, blood tests are done to check liver and kidney function and to ensure that you are not anaemic.
If the pain persists for longer than 10 days, or is severe and is not helped by taking paracetamol, or you feel faint, you will need to go to hospital immediately as this may be a sign that the tube has ruptured. Other occasional side effects (affecting up to 15% of patients) include nausea, indigestion, diarrhoea and sore mouth. For example, it could result in a greater chance of the baby having a neural tube defect such as hare lip, cleft palate, or even spina bifida or other NT defects. However, women often say they feel guilty that they want the pregnancy to be over when they are also grieving for the loss of their baby. With ectopic pregnancy, it is not really the stage of pregnancy (as in the number of weeks gestation), but the size of the ectopic, which can vary over the first few weeks depending on the rate of growth, that is important. It is these that rupture the tube, cause the pain and have the potential to cause internal bleeding to the mother. On or around day 4 following treatment, it is very normal to feel utterly exhausted and this is because the drug interferes with essential amino acids that give us energy as a side effect. This means that our babies are not growing and so for more than 90% of us in ectopic pregnancy our babies do not, and have ever had, a heartbeat. The appearance of the normal lining of the uterus by the presence and action of progesterone becomes decidualised. The American Academy of Paediatrics considers methotrexate to be contraindicated during breast feeding because of several potential problems, including immune suppression, neutropenia, adverse effects on growth, and carcinogenesis. Every 2-3 days, beta hCG levels will be monitored to ensure that they are falling appropriately. Very occasionally, changes in the blood count, liver and kidney function may occur, but these are usually temporary. The drug is metabolised quickly but can affect the quality of your cells, including those of your eggs and the quality of your blood for up to 3 or 4 months after it has been given. It is important you remember that the ectopic pregnancy was not your fault and that there was nothing you could have done to prevent it happening. For a more detailed understanding of when Methotrexate might be considered, both this protocol and the Greentop Guideline 21 might be helpful. Once these cells no longer divide, the pregnancy is ended and the whole pregnancy sac, including any cells that might eventually have grown into a baby, is usually reabsorbed by the mother. If you would like it to be considered as a treatment, you certainly are within your rights to ask to be referred to a centre of treatment where it is available. Or the tissue can separate from the tubal wall and be passed in the blood which is flowing out of the uterine cavity into the vagina. Most women only need one injection but in up to a quarter of cases a further injection may be required if serum hCG levels are not decreasing. Your doctors will usually test your hCG levels on the day the medicine is given, again on day 4, and on day 7 after the injections.
This may be due to the fact that medical treatment is non-invasive, whereas surgery may cause some scarring around the tube. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered.
You should ask to be referred to a consultant within the Primary Care Trust who can assess your suitability for this kind of treatment or on to another treatment centre.
You may feel pain after being given methotrexate but this is due to the pregnancy sac swelling and not due to effects on the baby. It is very unlikely that if a woman passes material like this it is her baby,  but she will often mistake it for that.
The tube, however, may remain blocked by the pregnancy tissue which can take some time to shrink. Once your blood hCG levels have dropped, if you wish to become pregnant again, you should recommence your folic acid supplements several weeks or months before you conceive. Occasionally it may not shrink and will leave a blockage in the tube, by way of a small cyst. However, the use of Methotrexate does not reduce the chances of successful future pregnancy, whatever the outcome in the affected tube.



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