A 33-year-old woman underwent right salpingectomy for a 5 cm ruptured ampullary ectopic. Her beta-hCG was 3,400 IU/L on postoperative day 1. At 2 weeks it is 3,160 IU/L and at 3 weeks 3,090 IU/L. She is well and afebrile. The most appropriate next step is:

• A Continue observation with weekly hCG alone
• B Total hysterectomy with left salpingectomy
• C Relaparotomy with wedge resection of the right cornu
• D Administer systemic methotrexate ✓

Explanation

Persistent trophoblastic tissue after ectopic surgery produces a plateauing or slowly falling hCG, and it occurs in roughly 5 to 20 percent of cases after conservative tubal surgery. In a stable, asymptomatic patient the standard treatment is systemic methotrexate, 50 mg per square metre intramuscularly, with hCG monitoring. Relaparotomy and hysterectomy are reserved for instability or failed medical management, and simple observation would allow continued trophoblast growth.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.