What is the treatment of choice of unrupturece tubal pergnancy with serum b-hCG titre 20001 U1 ml:

Ans. is a i.e Single dose of methotrexate The lady in the question is presenting with unruptured ectopic pregnancy with BhCG levels - 2000IU/L. So there is not doubt we can manage the patient medically (i.e. option d - ruled out) Expectant management as explained earlier is not better than medical management as it carries the risk of rupture of ectopic pregnancy (i.e. option C ruled out) and also it is done when riFICG levels are < 1000 IUL Now - The question arises whether we should give single dose MTx or multidose methotrexate treatment. In the trials which have been conducted - No difference was found in treatment duration, phCG levels and side effects in single dose vs multidose methotrexate therapy. Single dose therapy is more commonly used becasue of simplicity. It is less expensive, requires less invasive post therapy monitoring and does not require leucovorin supplementation. One trial has shown that multidose therapy has greater chance of success than single dose but this is not suppoed by any other trial so, single dose methotrexate is being used commonly. (So, it is our option of choice.) Also know : Single dose Medical treatment protocol for ectopic pregnancy. Day 0 / Day I = Measure serum r3hCG, TLC, DLC, Liver Function Test and Renal Function Test Day 2 = Single dose Methotrexate 50 mg/m2 IM given Day 4 = S. VilICG and counts repeated Day 7 = S. 13hCG and counts repeated Now if the decline in serum jhCG on Day 7 from day 4 is?15%/Fetal cardiac activity present Repeat methotrexate dose and begin new Day 1 Surgical treatment is indicated if rihCG levels not decreasing or fetal cardiac activity persists after three doses of methotrexate