Wishing I had more experience in obstetrics, I did my best to answer the questions of a young woman to whom I'd just administered IM methotrexate for ectopic pregnancy.
"How much bleeding should I expect? How much is too much?" the patient asks.
"The discharge instructions say to report bleeding to your OB," I read aloud from a patient handout provided by the clinic.
"Yes, but I've had some spotting since the beginning," she insists.
"Oh. Does your doctor know this?"
"Well, if there's more than what you've already experienced, call your doctor's office, day, night, or weekends."
As an oncology nurse, I have little idea how much bleeding is normal after receiving methotrexate for ectopic pregnancy.
Most oncology nurses administer chemotherapy to cancer patients, but some chemotherapy medications are used to treat non-oncological diagnoses too, such as methotrexate for treatment of ectopic pregnancy.
There are ongoing debates about where patients receiving chemotherapy for non-oncological conditions should be treated. Is it safe in non-oncological units like emergency departments or medical units? Who should administer chemotherapy?
At institutions where I have worked, only nurses who have completed education and demonstrated competence can administer chemotherapy for non-oncological diagnoses. Chemotherapy-competent nurses decrease risk to the patient. However, though experts in chemotherapy administration, oncology nurses may not have specialized education in non-oncological diagnoses, like ectopic pregnancy.
Although I still don't know how exactly much bleeding a woman should expect after receiving methotrexate for ectopic pregnancy, here are some important patient education points to cover:
- Ensure the woman has stopped taking prenatal vitamins and medications or products containing folic acid.
- Instruct her to avoid aspirin products and avoid alcohol until told by her obstetrician it is safe to resume.
- Caution her to avoid sexual intercourse and use contraception until told by her obstetrician it is safe to try again. Some literature says two months, but check with your institution's policies.
- Immediately report blood loss, severe abdominal pain/cramps, fever, or dizziness to her doctor.
- Make sure the woman knows when a follow-up appointment with her OB is scheduled, usually within four days of the injection, and again on day seven.
Don't forget the OB's office is a resource that can be contacted to answer concerns that you can't.
Not all women experiencing an ectopic pregnancy are in distress. While some are trying to start a family, others are not. As with any patient, let her set the emotional tone of the treatment and dictate the response she wants from a nurse.
This Medscape article is helpful reading. What are the experiences of TheONC community?