A patient treated with single-agent methotrexate for an ectopic pregnancy has a 15% drop in beta-hCG on day 4 (day 1 injection). What is the appropriate action?
- A The treatment is successful; no further intervention needed
- B A second dose of methotrexate should be given immediately
- C Measure beta-hCG again on day 7; a 15% drop from day 4 to day 7 is required for success ✓
- D Surgical intervention is mandatory as methotrexate has failed
Correct answer: C. Measure beta-hCG again on day 7; a 15% drop from day 4 to day 7 is required for success
Explanation
The single-dose methotrexate protocol (50 mg/m²) uses a day 4 and day 7 beta-hCG measurement. A transient rise in beta-hCG (up to 50% increase) from day 1 to day 4 is expected and does not indicate failure — this is a normal trophoblastic response. Success is defined as a ≥15% decline from day 4 to day 7 levels. If the day-4-to-day-7 decline is <15%, a second dose of methotrexate is given. Surgical intervention is reserved for haemodynamic instability, failed second dose, or contraindication to continued medical management.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.