Non-surgical management of ectopic pregnancy: appropriate risk management must be in place

Advances in technology have facilitated early diagnosis of ectopic pregnancy, which in turn has increased the scope for non-surgical treatment. Unfortunately risks associated with such management, including maternal death, are coming to the fore. This paper highlights the risks and how they could be avoided.

The risks include rupture of ectopic pregnancy during treatment with methotrexate or during expectant management, inadvertent administration of methotrexate to viable early intrauterine pregnancy, methotrexate embryopathy, allergic reaction to methotrexate, development of methotrexate pneumonitis and fatal administration of methotrexate to a woman with a concurrent medical problem.

There is an urgent need for appropriate risk management procedures to be applied in units where non-surgical (i.e. expectant or medical) management of ectopic pregnancy is offered. Risk management should address organisational issues such as safe handling of the chemotherapeutic agent, prescription and supply, consent (informed choice), documentation and adequacy of follow-up arrangements. Women undergoing non-surgical management should have ready access (for example by telephone) to professional advice and to surgical intervention in the event of an emergency.