A 22-year-old woman, G2P1, presented for evaluation 2 weeks after a missed menses. She stated, "If I am pregnant, I am interested in a medical abortion. I had a surgical abortion once, 3 years ago, and would rather not have that procedure again, if I don't need to." She has been treated for salpingitis twice over the last 4 years. The patient's sensitive urine pregnancy test was positive, and pelvic examination revealed a slightly enlarged uterus and a mildly tender right adnexal mass.
Because of the patient's history of salpingitis and her physical findings, the clinician ordered a serum ß-hCG, which returned at 3,100 mIU/mL. Transvaginal sonography revealed no gestational sac within the uterus. However, the right fallopian tube contained a gestational sac with a yolk sac, establishing the diagnosis of ectopic pregnancy.
Resolution of Case 8
After learning of the comparative risks and benefits of medical and surgical treatment options, the patient chose treatment with methotrexate. The patient received intramuscular methotrexate 50 mg/m2. She did well clinically, and her ß-hCG levels eventually fell to nondetectable levels.
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