Medical Ectopic Management
HCG: human chorionic gonadotropin; TVUS: transvaginal ultrasound;
MTX: methotrexate.
* Severe or persistent lower abdominal pain and/or evidence of hemoperitoneum.
Some clinicians treat with MTX for patients with hCG >5000 to ≤10,000 mIU/mL if the following criteria are met: no pathologic levels of free fluid in the pelvic cul-de-sac or abdomen, TVUS meets criteria for MTX, and the patient has minimal pelvic or abdominal pain.
- Ectopic mass diameter <3 to 4 cm is also commonly used as a patient selection criterion; however, this has not been confirmed as a predictor of successful treatment.
- A small portion of patients may be candidates for expectant management. For such patients, all of the following criteria must be present:
- Asyptomatic
- hCG ≤200 mIU/mL and decreasing
- Nondiagnostic TVUS (ie, no gestational sac and no extrauterine mass suspicious for ectopic pregnancy)
Expectant management includes measurement of serum hCG every two days for three measurements. If hCG is decreasing and the patient remains asymptomatic, serum hCG is obtained weekly until hCG is undetectable (usually within 10 weeks). All other patients are managed with surgery or MTX.