Ectopic Pregnancy With Low Beta-Human Chorionic Gonadotropin (HCG) Managed With Methotrexate and Progressed to Rupture

Abstract

Ectopic pregnancies are one of the most common obstetric diagnoses made in the emergency department. Once diagnosed, patients can be managed expectantly, medically, or surgically. Decisions regarding patient management are made using evidence-based protocols. Hemodynamically stable patients with reduced beta-human chorionic gonadotropin (HCG) levels and a small mass on ultrasonography are managed with methotrexate therapy. Although most patients adequately treated with methotrexate resolve, there are a few rare instances where patients progress to develop a ruptured ectopic despite having low and declining beta-HCG levels. These patients must be taken for surgical evacuation at the earliest opportunity to prevent life-threatening hemorrhage. Hence, obstetricians must be prepared for such potential complications of low-risk ectopic pregnancies.

Keywords: acute pain in pregnancy; ectopic pregnancy; high dose methotrexate; ob-gyn; patient under observation; ruptured ectopic pregnancy; ruptured tubal ectopic pregnancy; surgical evacuation; treatment protocol.