Ectopic Pregnancy

Question 1

What is the prevalence of ectopic pregnancy?

Answer 1

2%

Question 2

How does methotrexate work?

Answer 2

Folate antagonist
Blocks production of nucleotides
Inhibits DNA Synthesis
Affects actively dividing cells like gestational trophoblasts

Question 3

Absolute contradictions to MTX

Answer 3

Kidney
Liver
GI
Lung
Allergy to MTX
IUP
Breastfeeding
Blood disorders (hematopoietic)
Patient who are unable to follow-up

Question 4

Relative contraindications to MTX

Answer 4

Fetal cardiac activity
HCG > 5000
Size > 4 cm
Refusal to accept blood products

Question 5

Baseline screen prior to MTX

Answer 5

CBC
LFT
Cr
Blood type
HCG

Question 6

MTX regimen

Answer 6

Single: 50 mg/m2 on day 1
2-dose: 50 mg/m2 on day 1 and day 4
Multi dose: 1mg/kg on day 1,3,5,7 with folinic acid on 4,6,8

Question 7

MTX Treatment success

Answer 7

Check HCG on day 1, 4, and 7
15% decrease between 4 and 7

Question 8

MTX pearls

Answer 8

Avoid PNV, NSAIDs, and folate containing foods