••• Chapter 29^ Ectopic Pregnancy^287
❍ When is a second dose of methotrexate required?
A second dose is required if the hCG level does not fall by at least 15% between days 4 and 7 of administration or
if the levels subsequently plateau.
❍ What percentage of women require a second dose of therapy?
About 6% of women getting single-dose therapy require a second dose.
❍ What percentage of women are successfully treated with methotrexate?
Studies suggest that between 85% and 95% of women are successful with medical therapy.
❍ How does ectopic rate compare with medical versus surgical therapy?
The rate of repeat ectopic pregnancy following medical therapy compares favorably with surgical therapy
(8% vs. 15%).
❍ What percentage of patients treated with methotrexate rupture?
10% depending on location and initial hCG titer.
❍ What percentage of ectopic pregnancies will spontaneously resolve?
It has been estimated that up to 60% or more of ectopic pregnancies will resolve without therapy.
❍ What is the best predictor of spontaneous resolution of an ectopic pregnancy?
The initial hCG is the most important factor. Approximately 88% of patients with an initial hCG level
<200 mIU/mL will experience spontaneous resolution.
❍ If the hCG levels are falling, is surgery or medical therapy required in a patient with an ectopic pregnancy?
Treatment is only required if the patient is symptomatic or the hCG levels do not continue to fall. Active treatment
is indicated if compliance is a concern.
❍ What counseling should be provided to a woman with an ectopic pregnancy?
Women need to be aware of the decreased fecundity associated with a history of an ectopic pregnancy, as well
as the increased risk of another ectopic pregnancy. As with any pregnancy loss, supportive counseling should be
offered.
❍ How should a woman with a history of an ectopic pregnancy be followed in a subsequent pregnancy?
Early monitoring of the pregnancy with hCG levels and transvaginal ultrasound.