A hemodynamically stable patient with early pregnancy has adnexal mass of 2.5 x 3 cms and beta hCG titre of 1500 mIU /ml, with no intrauterine gestational sac. What modality of treatment is suitable for her
The history is suggestive of Ectopic pregnancy Management of Ectopic pregnancy Medical management Surgical management b-HCG levels <5000 mIU >5000 mIU Size of G-sac <4 cm >4 cm Cardiac activity -ve +ve Evidence of rupture none + Hemodynamics stable unstable Medical management of ectopic pregnancy Methotrexate: 50 mg/sq. m (IM) given as single dose, two dose or multiple dose regimens. Patient is followed up for adequate fall in beta HCG levels and for evidence of rutpure. If beta HCG levels do not fall, or there is any evidence of rupture surgical management is done Other drugs used are: Actinomycin D and KCL Conservative management may be done for patients with falling B Hcg levels. However tubal rupture can occur even with falling beta hcg levels. Patients with low initial levels of beta hcg are generally the best candidates for expectant management, and there is a repoed 88% success rate of spontaneous remission with an initial beta hcg levels of less than 200 mIU/mL.
Progesterone therapy
Medical management
Laparoscopic surgery
Laparotomy
Ectopic Pregnancy (Hello ! Where are you ?)