Ectopic pregnancy - Revision history

Danbot: Add MedicationDose SMW entry for methotrexate; dose verified against ACOG guidelines

2026-03-20T18:04:36Z

Add MedicationDose SMW entry for methotrexate; dose verified against ACOG guidelines

← Revisión anterior		Revisión del 18:04 20 mar 2026
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	*Most are admitted and/or go to the OR		*Most are admitted and/or go to the OR
	*Smaller, minimally symptomatic ectopic pregnancies being treated with methotrexate may be discharged in consultation with OB/GYN		*Smaller, minimally symptomatic ectopic pregnancies being treated with methotrexate may be discharged in consultation with OB/GYN


			==Medication Dosing==
			*{{MedicationDose\|drug=Methotrexate\|dose=50 mg/m2 IM\|route=IM\|context=Medical management (single dose regimen)\|indication=Ectopic pregnancy\|population=Adult\|notes=Repeat on day 7 if hCG decreases <15% between days 4-7; see ACOG contraindications}}

	==See Also==		==See Also==

Rossdonaldson1: /* Definitive Treatment */

2024-12-04T20:29:59Z

Definitive Treatment

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	***Size of ectopic mass may actually increase before involution, and this is not associated with treatment failure		***Size of ectopic mass may actually increase before involution, and this is not associated with treatment failure
	*Surgical treatment		*Surgical treatment
	**~~Urgent laparotomy if patient is unstable~~		**Laparascopic salpingectomy or salpingostomy
	**Otherwise, laparascopic salpingectomy or salpingostomy ~~can be done~~

	==Disposition==		==Disposition==

Rossdonaldson1: /* Management */

2024-12-04T20:29:16Z

Management

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	==Management==		==Management==
			===Emergency Treatment===
			*OB/GYN Consult
	*[[Rho(D) Immune Globulin (RhoGAM)\|RhoGAM]] for all Rh-negative women		*[[Rho(D) Immune Globulin (RhoGAM)\|RhoGAM]] for all Rh-negative women
	*OB/~~GYN Consult~~		*If unstable:
			**Urgent surgical laparotomy
			**Consider T&S and/or [[blood transfusion]] (e.g., [[MTP]]) as temporizing measure

			===Definitive Treatment===
	*Medical management with [[methotrexate]] (ACOG)		*Medical management with [[methotrexate]] (ACOG)
	**Single dose regimen<ref>Bachman EA and Barnhart K. Medical Management of Ectopic Pregnancy: A Comparison of Regimens. Clin Obstet Gynecol. 2012 Jun; 55(2): 440–447.</ref>		**Single dose regimen<ref>Bachman EA and Barnhart K. Medical Management of Ectopic Pregnancy: A Comparison of Regimens. Clin Obstet Gynecol. 2012 Jun; 55(2): 440–447.</ref>

Rossdonaldson1: /* Management */

2024-12-04T20:26:09Z

Management

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	==Management==		==Management==
	#[[Rho(D) Immune Globulin (RhoGAM)\|RhoGAM]] for all Rh-negative women		*[[Rho(D) Immune Globulin (RhoGAM)\|RhoGAM]] for all Rh-negative women
	#OB/GYN Consult		*OB/GYN Consult
	#Medical management with [[methotrexate]] (ACOG)		*Medical management with [[methotrexate]] (ACOG)
	#*Single dose regimen<ref>Bachman EA and Barnhart K. Medical Management of Ectopic Pregnancy: A Comparison of Regimens. Clin Obstet Gynecol. 2012 Jun; 55(2): 440–447.</ref>		**Single dose regimen<ref>Bachman EA and Barnhart K. Medical Management of Ectopic Pregnancy: A Comparison of Regimens. Clin Obstet Gynecol. 2012 Jun; 55(2): 440–447.</ref>
	#**[[Methotrexate]] 50mg/m2 IM day 1		***[[Methotrexate]] 50mg/m2 IM day 1
	#**If hCG decreases by <15% between days 4 and 7, another 50mg/m2 IM [[methotrexate]] on day 7		***If hCG decreases by <15% between days 4 and 7, another 50mg/m2 IM [[methotrexate]] on day 7
	#*Absolute contraindications		**Absolute contraindications
	#**Breast-feeding		***Breast-feeding
	#**Laboratory evidence of immunodeficiency		***Laboratory evidence of immunodeficiency
	#**Preexisting blood dyscrasias (bone marrow hypoplasia, [[leukopenia]], [[thrombocytopenia]], or clinically significant [[anemia]])		***Preexisting blood dyscrasias (bone marrow hypoplasia, [[leukopenia]], [[thrombocytopenia]], or clinically significant [[anemia]])
	#**Known sensitivity to methotrexate		***Known sensitivity to methotrexate
	#**Active pulmonary disease		***Active pulmonary disease
	#**[[Peptic ulcer disease]]		***[[Peptic ulcer disease]]
	#**Hepatic, renal, or hematologic dysfunction		***Hepatic, renal, or hematologic dysfunction
	#**Alcoholism		***Alcoholism
	#**Alcoholic or other chronic liver disease		***Alcoholic or other chronic liver disease
	#**Coexistant viable IUP		***Coexistant viable IUP
	#**Does not have timely access to medical institution, or unwilling/unable to comply with post-MTX monitoring		***Does not have timely access to medical institution, or unwilling/unable to comply with post-MTX monitoring
	#*Relative contraindications		**Relative contraindications
	#**Adnexal mass >3.5 cm in largest diameter		***Adnexal mass >3.5 cm in largest diameter
	#**Presence of fetal heart rate		***Presence of fetal heart rate
	#**Free fluid visualized in Pouch of Douglas		***Free fluid visualized in Pouch of Douglas
	#**[[Beta-HCG]] >5000mIU/mL		***[[Beta-HCG]] >5000mIU/mL
	#*Note: Need to counsel patient to return after 4 and 7 days to recheck hCG values to check for satisfactory decline		**Note: Need to counsel patient to return after 4 and 7 days to recheck hCG values to check for satisfactory decline
	#*Also note that 30-60% of women experience "separation pain" ~1 week after starting methotrexate<ref>Lipscomb GH et al. Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy. Obstet Gynecol. 1999 Apr;93(4):590-3.</ref>		**Also note that 30-60% of women experience "separation pain" ~1 week after starting methotrexate<ref>Lipscomb GH et al. Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy. Obstet Gynecol. 1999 Apr;93(4):590-3.</ref>
	#**Thought to be due to tubal distention from tubal abortion or hematoma formation		***Thought to be due to tubal distention from tubal abortion or hematoma formation
	#**Nevertheless, presentation of abdominal pain at this time still warrants an US to look for tubal rupture, which may be indicated by increase in pelvic free fluid, decrease in Hb		***Nevertheless, presentation of abdominal pain at this time still warrants an US to look for tubal rupture, which may be indicated by increase in pelvic free fluid, decrease in Hb
	#**Size of ectopic mass may actually increase before involution, and this is not associated with treatment failure		***Size of ectopic mass may actually increase before involution, and this is not associated with treatment failure
	#Surgical treatment		*Surgical treatment
	#*Urgent laparotomy if patient is unstable		**Urgent laparotomy if patient is unstable
	#*Otherwise, laparascopic salpingectomy or salpingostomy can be done		**Otherwise, laparascopic salpingectomy or salpingostomy can be done

	==Disposition==		==Disposition==

Rossdonaldson1: /* Background */

2024-05-01T16:50:14Z

Background

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	==Background==		==Background==
			[[File:Figure 28 02 01.png\|thumb\|Normal female anatomy with uterus highlighted.]]
	*Leading cause of maternal death in first trimester and overall third leading cause of maternal death		*Leading cause of maternal death in first trimester and overall third leading cause of maternal death
	*Occur in 2% of all pregnancies<ref>Centers for Disease Control and Prevention. Current trends ectopic pregnancy - United States, 1990-92. MMWR Morb Mortal Wkly Rep. 1995; 44:46-48.</ref> and as high as 6-16% in those presenting to the ED<ref>Houry D and Keadey M. Complications in pregnancy part I: Early pregnancy. EBM. 2007; 9(6):1-28.</ref>		*Occur in 2% of all pregnancies<ref>Centers for Disease Control and Prevention. Current trends ectopic pregnancy - United States, 1990-92. MMWR Morb Mortal Wkly Rep. 1995; 44:46-48.</ref> and as high as 6-16% in those presenting to the ED<ref>Houry D and Keadey M. Complications in pregnancy part I: Early pregnancy. EBM. 2007; 9(6):1-28.</ref>

Rossdonaldson1: /* Differential Diagnosis */

2023-05-03T16:32:19Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
	{{VB DDX less than 20}}		{{VB DDX less than 20}}

	{{Pelvic pain DDX}}		{{Pelvic pain DDX}}

Elcatracho: /* Specific Types by Location */

2021-02-08T23:28:15Z

Specific Types by Location

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	===Specific Types by Location===		===Specific Types by Location===
			''Most common location is the ampulla of the fallopian tube''

	====Cervical Ectopic====		====Cervical Ectopic====
	*Very rare with delayed diagnoses due to decreased accuracy of US		*Very rare with delayed diagnoses due to decreased accuracy of US

ClaireLewis at 19:10, 3 October 2019

2019-10-03T19:10:48Z

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	''Must consider in all women of childbearing age with [[abdominal pain\|abdominal]] and/or [[pelvic pain]]''		''Must consider in all women of childbearing age with [[abdominal pain\|abdominal]] and/or [[pelvic pain]]''
	*Ruptured		*Ruptured
	**Shock		**[[hemorrhagic shock\|Shock]]
	**Rebound tenderness		**Rebound tenderness
	*Non-ruptured (early)		*Non-ruptured (early)
	**Abdominal/pelvic pain		**[[abdominal pain\|Abdominal]]/[[pelvic pain]]
	**Vaginal bleeding		**[[Vaginal bleeding]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	#[[Rho(D) Immune Globulin (RhoGAM)\|RhoGAM]] for all Rh-negative women		#[[Rho(D) Immune Globulin (RhoGAM)\|RhoGAM]] for all Rh-negative women
	#OB/GYN Consult		#OB/GYN Consult
	#Medical management with methotrexate (ACOG)		#Medical management with [[methotrexate]] (ACOG)
	#*Single dose regimen<ref>Bachman EA and Barnhart K. Medical Management of Ectopic Pregnancy: A Comparison of Regimens. Clin Obstet Gynecol. 2012 Jun; 55(2): 440–447.</ref>		#*Single dose regimen<ref>Bachman EA and Barnhart K. Medical Management of Ectopic Pregnancy: A Comparison of Regimens. Clin Obstet Gynecol. 2012 Jun; 55(2): 440–447.</ref>
	#**[[Methotrexate]] 50mg/m2 IM day 1		#**[[Methotrexate]] 50mg/m2 IM day 1
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	#**Breast-feeding		#**Breast-feeding
	#**Laboratory evidence of immunodeficiency		#**Laboratory evidence of immunodeficiency
	#**Preexisting blood dyscrasias (bone marrow hypoplasia, leukopenia, thrombocytopenia, or clinically significant anemia)		#**Preexisting blood dyscrasias (bone marrow hypoplasia, [[leukopenia]], [[thrombocytopenia]], or clinically significant [[anemia]])
	#**Known sensitivity to methotrexate		#**Known sensitivity to methotrexate
	#**Active pulmonary disease		#**Active pulmonary disease
	#**Peptic ulcer disease		#**[[Peptic ulcer disease]]
	#**Hepatic, renal, or hematologic dysfunction		#**Hepatic, renal, or hematologic dysfunction
	#**Alcoholism		#**Alcoholism

Rossdonaldson1: /* Repeat B-hCG Levels */

2018-12-18T23:15:06Z

Repeat B-hCG Levels

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	*Patients should have a 48hr repeat B-HCG level checked to determine if appropriate doubling is occurring.		*Patients should have a 48hr repeat B-HCG level checked to determine if appropriate doubling is occurring.

	~~===Repeat [[B-hCG]] Levels===~~
	{{Repeat B-hCG levels}}		{{Repeat B-hCG levels}}

Rossdonaldson1: /* Background */

2018-12-18T22:44:44Z

Background

@@ Línea 27: / Línea 27: @@
 | Previous intrauterine device use||1.6
 |}
 ==Clinical Features==