Question

A 24 year old female pt. With weeks of amenorrhea, left adnexal mass on USG, B-hcg 2500, no fetal heart rate. What's the management?

• A. Expectant management
• B. Single dose methotrexate
• C. Single dose methotrexate
• D. Milking of tube

Answer 1

The Correct Option is C

A 24-year-old woman presents with several weeks of amenorrhea, a left adnexal mass visible on ultrasound, a beta-hCG level of 2500 mIU/mL, and no detectable fetal heart rate. These findings are indicative of a possible ectopic pregnancy, particularly given the presence of an adnexal mass coupled with an elevated beta-hCG level and the absence of intrauterine pregnancy signs.

In ectopic pregnancy management, several factors are considered: the patient's hemodynamic stability, beta-hCG levels, and any existing contraindications to medical treatment. In this case, the beta-hCG level is 2500 mIU/mL, the patient is hemodynamically stable, and there are no indications of acute rupture.

Single-dose methotrexate is often utilized for the medical management of unruptured ectopic pregnancies in stable patients with a beta-hCG level below 5000 mIU/mL. Methotrexate, a folic acid antagonist, inhibits rapidly dividing cells which can help resolve the ectopic gestation.

Given the patient’s profile and findings:

• Expectant management: Not suitable due to the elevated beta-hCG and adnexal mass indicating an ectopic pregnancy, which requires active intervention.
• Single dose methotrexate: This is appropriate due to the beta-hCG level of 2500 and the stability of the patient without signs of rupture.
• Milking of tube: A surgical technique not typically indicated in this medically stable patient.

Therefore, the appropriate management for this patient is single dose methotrexate to medically treat the suspected ectopic pregnancy.