In the event that pelvic-organ rupture has occurred because of the ectopic pregnancy, internal bleeding and/or hemorrhage may lead to shock. This is the first symptom of nearly 20% of ectopic pregnancies.

It is an emergency condition. Therefore, initial treatment may be needed to address shock by keeping the woman warm, elevating her legs, and administering oxygen. Treatment with intravenous fluids and sometimes a blood transfusion is performed as soon as possible.

Surgical laparotomy is performed to stop the immediate loss of blood (in cases in which rupture has already occurred), or to confirm the diagnosis of ectopic pregnancy, remove the products of conception, and repair surrounding tissue damage as much as possible. In some cases, removal of the involved fallopian tube may be necessary.

In non-emergency cases, mini-laparotomy or laparoscopy are the most common surgical treatments. Such procedures have similar outcomes. However, they are less invasive and are available at a lower cost because they require minimal hospitalization or outpatient treatment.

Non-surgical (medical) management is being implemented in many medical centers for ectopic pregnancies without suspected immediate danger of rupture. In such cases, methotrexate is administered with careful outpatient monitoring of the woman and serial quantitative HCGs, CBCs, and liver funtion tests.

About 85% of the women who have experienced one ectopic pregnancy are later able to achieve a normal pregnancy. A subsequent ectopic pregnancy may occur in 10 to 20% of cases. Some women fail to become pregnant again, while others become pregnant and spontaneously abort during the first trimester.

The maternal death rate from ectopic pregnancy in the U.S. has decreased in the last 30 years to less than 0.1%.

• Rupture, with resulting hemorrhage leading to shock and the risk of requiring a blood transfusion or rarely of death, is the most common complication.
• Infertility occurs in 10 to 15% of women who have experienced an ectopic pregnancy.