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Medical Management of Ectopic Pregnancy

LIPSCOMB, GARY H. MD

Clinical Obstetrics & Gynecology: June 2012 - Volume 55 - Issue 2 - p 424–432
doi: 10.1097/GRF.0b013e3182510a48
Ectopic Pregnancy

The use of medical management of ectopic pregnancy has become an accepted alternative to surgical therapy. Methotrexate, a folic acid antagonist, is the most widely studied agent. The most commonly used protocol consists of methotrexate 50 mg/m2 of actual body weight. Assessment of human chorionic gonadotropin (hCG) levels is repeated on days 4 and 7. Repeat methotrexate dosing is performed for hCG drops <15%. Contraindications include hemodynamically unstable patients or those with elevated liver enzymes, low white blood count, or abnormal renal function. hCG levels are most predictive of success. A success rate of above 90% is achievable.

Departments of Family Medicine; Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, Tennessee

The author declares that he has nothing to disclose.

Correspondence: Gary H. Lipscomb, MD, Department Family Medicine, 1301 Primacy Parkway, Memphis, TN 38119. E-mail: glipscomb@uthsc.edu

© 2012 Lippincott Williams & Wilkins, Inc.