Single dose regimen
Methotrexate 50mg/m2 IM day 1
If hCG decreases by <15% between days 4 and 7, another 50mg/m2 IM methotrexate on day 7
Absolute contraindications
Breast-feeding
Laboratory evidence of immunodeficiency
Preexisting blood dyscrasias (bone marrow hypoplasia, leukopenia, thrombocytopenia, or clinically significant anemia)
Known sensitivity to methotrexate
Active pulmonary disease
Peptic ulcer disease
Hepatic, renal, or hematologic dysfunction
Alcoholism
Alcoholic or other chronic liver disease
Coexistant viable IUP
Does not have timely access to medical institution, or unwilling/unable to comply with post-MTX monitoring
Relative contraindications
Adnexal mass >3.5 cm in largest diameter
Presence of fetal heart rate
Free fluid visualized in Pouch of Douglas
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
Also note that 30-60% of women experience "separation pain" ~1 week after starting methotrexate
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
Size of<unk>  mass may actually increase before involution, and this is not associated with treatment failure
Methotrexate 50mg/m2 IM day 1
If hCG decreases by <15% between days 4 and 7, another 50mg/m2 IM methotrexate on day 7
Breast-feeding
Laboratory evidence of immunodeficiency
Preexisting blood dyscrasias (bone marrow hypoplasia, leukopenia, thrombocytopenia, or clinically significant anemia)
Known sensitivity to methotrexate
Active pulmonary disease
Peptic ulcer disease
Hepatic, renal, or hematologic dysfunction
Alcoholism
Alcoholic or other chronic liver disease
Coexistant viable IUP
Does not have timely access to medical institution, or unwilling/unable to comply with post-MTX monitoring
Adnexal mass >3.5 cm in largest diameter
Presence of fetal heart rate
Free fluid visualized in Pouch of Douglas
Beta-HCG >5000mIU/mL
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
Size of<unk>  mass may actually increase before involution, and this is not associated with treatment failure
Urgent laparotomy if patient is unstable
Otherwise, laparascopic salpingectomy or salpingostomy can be done
Ectopic pregnancy
Ovarian torsion
Subchorionic hematoma
Tubo-ovarian abscess
First Trimester Abortion
Ovarian cyst
Complete Abortion
Endometriosis