A woman treated with single-dose methotrexate for ectopic pregnancy has an hCG of 3200 IU/L on day 1. On day 4, hCG rises to 4100 IU/L. What is the most appropriate next step?
- A Repeat the hCG on day 7; a 15% fall from day 4 to day 7 indicates success ✓
- B Immediate surgical intervention; the treatment has failed
- C Repeat the hCG on day 7 and compare with day 4 value; day 1–4 rise is expected
- D Administer a second dose of methotrexate immediately
Correct answer: A. Repeat the hCG on day 7; a 15% fall from day 4 to day 7 indicates success
Explanation
After single-dose methotrexate for ectopic pregnancy, hCG typically rises or remains plateaued between days 1 and 4 — this is expected and does not indicate treatment failure. Treatment success is determined by measuring hCG on day 4 and day 7: a fall of ≥15% from day 4 to day 7 indicates adequate response. If the fall is <15%, a second dose of methotrexate is given or surgery is performed. The patient should be counselled about this normal pattern to prevent unnecessary alarm.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.