New drug for ectopic pregnancy to begin trial

Centre for Reproductive Health researchers are contributing to a trial of a new drug for the treatment of ectopic pregnancy. The drug could help hundreds of women every year avoid emergency surgery.

Funded by a Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR) partnership, the University of Aberdeen-led team will investigate whether a drug called mifepristone is more effective at treating ectopic pregnancy than the current medical treatment. 

Around 1 in 80 pregnancies are ectopic, which means the embryo starts to grow in the wrong place, often outside the uterus and usually in one of the Fallopian tubes. As it grows, there is a risk that the Fallopian tube can burst which can lead to life-threatening internal bleeding. When this happens, emergency surgery to remove the affected Fallopian tube is usually necessary and can be lifesaving.  

More recently, improved diagnosis of ectopic pregnancy has meant that some women can be treated with medication which reduces the need for surgery. However, with current medical treatment, up to 30 percent of women will still require emergency surgery and removal of their Fallopian tube.  

The research team hope this trial will demonstrate that treatment with mifepristone alongside the existing drug treatment, methotrexate, will reduce the need for emergency surgery for many women. Mifepristone which works by blocking progesterone, a key hormone of pregnancy.

The trial will be led by Dr Andrea Woolner, Senior Clinical Lecturer at the University of Aberdeen, along with a team of experts including Professor Andrew Horne, Director of the University of Edinburgh Centre for Reproductive Health, and others at the Universities of Nottingham and Birmingham, University College London, Monash University, Australia, Imperial College London and The Ectopic Pregnancy Trust.  

Ectopic pregnancies are a significant contributor to maternal illness and death worldwide. More effective medical treatments are needed to reduce the need for emergency surgery.

Professor Andrew Horne, Director of the Centre for Reproductive Health

Helen, 43, from Cardiff, is Project Co-ordinator at The Ectopic Pregnancy Trust - one of the organisations feeding into the trial. Helen experienced two ectopic pregnancies before having twins four years ago using IVF:

The first ectopic pregnancy I had ended up with a ruptured Fallopian tube so I had to have surgery where I lost the tube. This was extremely hard for me - I felt like I had to learn to walk and live again all in one go, whilst trying to heal both physically and mentally. 

It took a good few years of healing before I felt ok again. I had never had any surgery previously, let alone any major unexpected surgery, so this was difficult to process both physically and mentally for some time. 

With my second ectopic pregnancy, I lost my remaining Fallopian tube. Whilst this was an 'easier' surgery, I found this more mentally challenging than the first as I was also going through some major life changes at the same time.

Having suffered two ectopic pregnancies, with the first being medically managed with methotrexate but unfortunately rupturing that same evening, I believe the new drug trial offers a valuable opportunity to support those experiencing ectopic pregnancies and potentially help them avoid surgery.

Helen, Project Co-ordinator at The Ectopic Pregnancy Trust

Ectopic pregnancy is a devastating pregnancy loss which has significant physical and psychological impacts on women and their families, and the medical management of ectopic pregnancy has essentially had no advances in over 20 years. 

This is a really exciting opportunity to trial an additional drug alongside standard treatment for medical management of ectopic pregnancy. During the course of this trial, we plan to recruit women who are eligible for medical treatment of ectopic pregnancy across 40 early pregnancy units in the UK.

We strongly believe that the addition of mifepristone to standard treatment could reduce the need for emergency surgery.” 

Dr Andrea Woolner, Trial Chief Investigator

Munira Oza, Chief Executive of The Ectopic Pregnancy Trust, a UK wide charity dedicated to ectopic pregnancy, commented:

With emergency surgery often being required in ectopic pregnancy, the loss of control that a woman feels through the physical trauma, the lack of treatment choice, or potential failure of treatment, can contribute to considerable psychological impacts. 

Working with hundreds of women each year, we regularly hear about these intense physical and emotional effects of ectopic pregnancy. 

There is very much a need to consider and investigate alternative treatments. Earlier diagnosis, ongoing research, and the hope of more treatment options can help to expand patient choice and reduce some of the physical and emotional burden of ectopic pregnancy.

We wholeheartedly welcome this trial.

Around one in 80 pregnancies are ectopic, which can be life-threatening. This new trial could be a game-changer in helping hundreds of women avoid emergency surgery each year.

I look forward to seeing the results of this important research which could play a big part in reducing the physical and psychological trauma suffered by so many women during ectopic pregnancies.

This government is prioritising women’s health as we reform the NHS.

Baroness Merron, Parliamentary Under-Secretary of State at the Department of Health and Social Care

The trial is due to start later this year across the country and results are expected in 2027.

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