A 20-year-old woman arrives at the clinic with a complaint of lower abdominal pain (pain scale 2/ l 0) and light vaginal bleeding. In doing an initial intake history, it is discovered that her last menstrual period was six weeks ago. A urine pregnancy test is perfonned with a positive result. Her vital signs are 1 10/68, 98’, 84, 18. Her b-HCG level is 1,800 mIU/mL, and a transvaginal ultrasound shows no evidence of an intrauterine pregnancy. Upon bimanual examination, a small, irregular right adnexal mass was palpated.
A diagnosis of an early ectopic pregnancy was made. The patient received an appropriate dosage of methotrexate IM and was advised to return on days four and seven after the injection for repeat levels of b-HCG to be drawn. When she returns on days four and seven, the b-HCG levels are l,900 mlU/ml. and 1,000 mIU/mL, respectively. Her bleeding and abdominal pain has resolved by day seven. She is then scheduled to return weekly for repeat b-HCG levels.