Hi and welcome,
There are different protocols that are used. A decline in the value between day 0 and 4 predicts that the treatment will be more likely successful with a single dose.
Generally a serum HCG
on day 4 after therapy is compared with day 7. If the decrease from day 4 value is more than 15% nothing is done. If it is less, a second dose of methotrexate
may be given. The size of the sac and presence of fetal heart beat in any would have helped in providing a better opinion.
However the patient needs close monitoring during the entire period. In my clinic, I prefer in hospital management and do not send my patient home. A pulse and BP record as well as symptom record is kept so that if there is a rupture she may be operated easily.
If at any time you find that you are having increase in pain, palpitations [ awareness of heart beat] giddiness, difficulty in breathing, please rush to the ER.
The spotting happens sometimes in ectopic as the uterine lining is shed off.
If you do not have any new symptoms, it is OK just wait for second test.
Thanks for using HCM and take care.
Dr Nilajkumar Bagde
Consultant Obstetrician and Gynecologist