Question

A female presents to you with 6 weeks of amenorrhea complaining of bleeding per vagina and slight abdominal pain. The urine pregnancy test is positive and hCG level is 2800 IU/L. A mass is seen on the left adnexa measuring 3 x 2.5 cm. She is hemodynamically stable. How will you manage this patient?
hCG-Human chorionic gonadotropin

• A. Oral methotrexate
• B. Single-dose methotrexate injection
• C. Serial methotrexate + leucovorin rescue
• D. Salpingectomy

Answer 1

The Correct Option is B

The clinical presentation is suggestive of an ectopic pregnancy. This is supported by the following observations: amenorrhea for 6 weeks, positive urine pregnancy test, elevated hCG level, abdominal pain, and the presence of an adnexal mass. The patient is hemodynamically stable, which allows for medical management options.

Management Approach: 

• Confirm Ectopic Pregnancy: Based on the symptoms and diagnostic findings, the suspicion of an ectopic pregnancy is high.
• Consideration for Methotrexate Therapy: Methotrexate is a folic acid antagonist used to treat ectopic pregnancies in hemodynamically stable patients with certain criteria:
  • hCG level less than 5,000 IU/L, (patient's level is 2800 IU/L),
  • Adnexal mass size typically less than 3.5 cm, (patient's mass is 3 x 2.5 cm),
  • No fetal cardiac activity detected.
• Single-dose Methotrexate Injection: It is the most appropriate management in this case due to the stable condition and the parameters meeting criteria for medical management. This approach helps in resolving the ectopic pregnancy without surgical intervention.

Conclusion: Given the patient's stability and the presence of a small adnexal mass with a relatively low hCG level, the recommended management is a single-dose methotrexate injection to medically manage the ectopic pregnancy.