A 28-year-old woman presents at 6 weeks gestation with minor left-sided pelvic pain and no vaginal bleeding. She lives 5 minutes from the hospital. Her HCG level is 1342 mIU/ml. A... A 28-year-old woman presents at 6 weeks gestation with minor left-sided pelvic pain and no vaginal bleeding. She lives 5 minutes from the hospital. Her HCG level is 1342 mIU/ml. A transvaginal ultrasound reveals an anteverted uterus (80*40mm) with a 25 mm thick endometrium. No intrauterine pregnancy is seen. The right ovary appears normal. On the left adnexa, an echogenic ring measuring 29 mm is seen, suggestive of ectopic pregnancy without fetal heart activity. What is the first-line treatment to be offered?
Understand the Problem
The question describes a clinical scenario of a 28-year-old woman presenting with symptoms suggestive of a possible ectopic pregnancy. Given her clinical presentation, HCG level, and ultrasound findings, we need to determine the first-line treatment option.
Answer
First-line treatment should be medical management with methotrexate, if the patient is stable and meets the criteria for methotrexate therapy.
Given the patient's presentation (6 weeks gestation, left-sided pelvic pain, no vaginal bleeding, HCG level of 1342 mIU/ml, and ultrasound findings suggestive of ectopic pregnancy), the first-line treatment should be medical management with methotrexate, if the patient is stable and meets the criteria for methotrexate therapy. The patient also lives close to the hospital, this would make follow up easier.
Answer for screen readers
Given the patient's presentation (6 weeks gestation, left-sided pelvic pain, no vaginal bleeding, HCG level of 1342 mIU/ml, and ultrasound findings suggestive of ectopic pregnancy), the first-line treatment should be medical management with methotrexate, if the patient is stable and meets the criteria for methotrexate therapy. The patient also lives close to the hospital, this would make follow up easier.
More Information
Methotrexate is a medication that stops the growth of the ectopic pregnancy. It is effective in early ectopic pregnancies without fetal heart activity.
Tips
It is important to rule out other conditions that can cause similar symptoms, such as miscarriage or ovarian cyst. If the patient does not meet the criteria for methotrexate therapy or if medical management fails, surgical management may be necessary.
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