Professor Stephen Tong
Monash University
24 January 2017

Professor Stephen Tong and the team of investigators are revolutionising the treatment of ectopic pregnancy, meaning most women presenting with the condition could be treated medically, rather than surgically. Not only will this make treating ectopic pregnancies safer, easier and more effective, but it may save many lives across the developing world where surgery is not possible.

This story is part of our 10 of the Best, 2015 edition. 10 of the Best is an annual NHMRC publication, showcasing 10 NHMRC-funded health and medical research projects.

(L–R) Professor Terrance Johns, Professor Stephen Tong, Dr Monika Skubisz.

Ectopic pregnancies complicate one to two per cent of all pregnancies1 and contribute to three to eight per cent of all pregnancy related deaths.2

Professor Stephen Tong’s research is focussed on pursuing scientific discoveries to improve the care of pregnant women. His group (Translational Obstetrics Group, now based at The University of Melbourne) is tackling major complications of pregnancy and searching for better treatments to make pregnancy safer.

Professor Tong’s motivation for pursuing translational research stems from his clinical practice as a specialist obstetrician and gynaecologist.

'I continue to manage serious diseases that put women, mothers and babies at risk,' he explained.

The team of investigators, lead by Professor Tong, worked to develop novel ways to cure ectopic pregnancies with medication alone, potentially allowing women to avoid surgery and enhance their chance of a future healthy pregnancy.

Currently, most ectopic pregnancies are treated surgically. While the surgery is safe, there are still risks associated with any surgical treatment.

If an ectopic pregnancy is small, a drug called methotrexate can be used to clear the ectopic pregnancy medically.

'Unfortunately, methotrexate is only effective if the ectopic pregnancy is small. Therefore, most ectopic pregnancies still require surgery.

'We have identified a new medication treatment to treat ectopic pregnancies that we hope may be considerably more effective than methotrexate alone', Professor Tong said.

'This would medicalise what is currently regarded as a surgical condition, and may arguably revolutionise the treatment of this important condition.'

The team is exploring the benefits of combining methotrexate with another drug called gefitinib, which is hoped to treat effectively most cases of ectopic pregnancies.

'We are very hopeful that the combination of methotrexate and gefitinib could be used to improve the treatment of ectopic pregnancy.

'Specifically, we hope it can be used to efficiently resolve larger ectopic pregnancies that currently require surgery.

'Even for smaller ectopic pregnancies, we hope the combination may be able to clear ectopic pregnancies much quicker than methotrexate alone', Professor Tony remarked.

So far, the results are extremely encouraging. The team found the drug combination cured ectopic pregnancies 34 per cent faster than methotrexate alone, reducing risk of fallopian tube rupture and averting the need for surgery.3

Importantly, the combination appears safe and a number of women have had subsequent successful pregnancies.

The team has recently completed a clinical trial of women presenting with large ectopic pregnancies (many of these women would have been offered surgery immediately if they presented for routine clinical care). There was an 86 per cent success of all those treated with combination of methotrexate and gefitinib, thus removing the need for surgery.

Next steps

Professors Tong and Horne have commenced a large a randomised placebo controlled clinical trial, comparing the use of methotrexate alone versus combining methotrexate and gefitinib. It will be rolled out across 25 to 50 hospitals in the United Kingdom this year. If the trial yields positive results, it is hoped this treatment will be widely integrated into clinical care.

What is ectopic pregnancy?

Ectopic pregnancy is a complication where the embryo attaches outside the uterus. It is a life-threatening condition that complicates up to two percent of all pregnancies. Without treatment, ectopic pregnancy can rupture major blood vessels, causing fatal internal bleeding. It is the cause of up to eight per cent of pregnancy-related deaths.

There is an increased risk of an ectopic pregnancy if the fallopian tube is scarred or damaged. Risk factors include pelvic surgery, previous ectopic pregnancy and pelvic inflammatory disease arising from infection. However, for many women diagnosed with an ectopic pregnancy, there is no obvious risk factor.

1 BMJ 2011 342:d2297

2 BJOG 2011;118 [Supp 1]:1-203

3 Obstet Gynecol 2013;122:745-51.