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On methotrexate, took injection for ectopic pregnancy treatment, tests do not show change in hcg levels, have occasional spotting. Advise?

Hello. I am currently on methotrexate to treat an ectopic pregnancy . I had the injection Friday, at which point my hcg was around 2400. I had my labs checked again today, and the obgyn RN called me to tell Memy levels have stayed the same. However, I understand it s really the second hcg test that will tell if treatment worked. I m concerned that there was no change at allot my levels, I have left sided mild aching and the occasional blood clot, light spotting. Any recommendations or reassurance? I called my clinic back, but did not receive a call back.
Asked On : Fri, 14 Sep 2012
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OBGYN 's  Response
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
Answered: Sat, 22 Mar 2014
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