Question

A 24 year old female patient with weeks of amenorrhea, left adnexal mass on USG, B-hCG 2500, no fetal heart rate. What is the management?

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

Hint:

Check whether the beta-hCG level and absence of cardiac activity make this patient suitable for non-surgical management of ectopic pregnancy.

Answer 1

The Correct Option is C

Approach: This question tests management of ectopic pregnancy using the methotrexate criteria.

Given data: amenorrhea + left adnexal mass on USG + $\beta$-hCG = 2500 mIU/mL + no fetal cardiac activity.

Methotrexate criteria (all must be met):
1. Hemodynamically stable patient
2. $\beta$-hCG < 5000 IU/L
3. No fetal cardiac activity on USG
4. Patient compliant with monitoring

Here: $\beta$-hCG = 2500 (below 5000), no cardiac activity -- criteria satisfied.

Methotrexate (MTX) is a folic acid antagonist that inhibits dihydrofolate reductase, blocking purine and thymidylate synthesis in actively dividing trophoblast cells.

Single-dose MTX regimen: 50 mg/m$^2$ IM, followed by serial $\beta$-hCG monitoring on days 4 and 7. A fall of >15% from day 4 to day 7 indicates success.

Salpingectomy is for hemodynamically unstable patients. Expectant management is for very low and declining $\beta$-hCG. Milking (fimbrial expression) has higher recurrence rates and is not recommended.

\[\boxed{\text{Single dose methotrexate}}\]