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

Step 1: Identify the diagnosis. The clinical scenario describes a 24-year-old female with amenorrhea, left adnexal mass on ultrasound, serum beta-hCG of 2500 mIU/mL, and absent fetal cardiac activity. This is consistent with an ectopic pregnancy (most likely tubal).

Step 2: Assess suitability for medical management. The criteria for methotrexate (MTX) therapy in ectopic pregnancy include:

• Hemodynamic stability
• Serum beta-hCG < 5000 IU/L (here it is 2500 mIU/mL -- within range)
• Absence of fetal cardiac activity on ultrasound
• Patient willingness and ability to comply with follow-up

All criteria are met in this case.

Step 3: Select the correct management. Single-dose methotrexate (a folic acid antagonist) inhibits DNA synthesis in rapidly dividing trophoblastic cells. It has a success rate of up to 94% in appropriately selected patients. Salpingectomy is reserved for hemodynamically unstable patients or those who fail medical management. Expectant management is used when beta-hCG is very low and falling. Milking of tube (fimbrial expression) is associated with higher recurrence and is not preferred.

Conclusion: Single dose methotrexate is the treatment of choice here.