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Suspected Ectopic Pregnancy
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TVUS + quantitative β-hCG drive decisions.
Decision
Outcome
Decision
Positive β-hCG + lower abd pain ± bleeding. Stability?
✓
Stable → TVUS + quantitative β-hCG
✓
Unstable → immediate surgical consultation
Decision
TVUS?
✓
Adnexal mass → treat as ectopic
✓
IUP → confirmed intrauterine pregnancy
✓
Non-diagnostic → use β-hCG threshold
Decision
Choice of management?
✓
MTX criteria met (stable, β-hCG <5000, no fetal cardiac activity, ≤3.5 cm, can follow up) → methotrexate
✓
Criteria not met → salpingostomy or salpingectomy
Outcome
Methotrexate + weekly β-hCG until undetectable
Avoid folic acid, NSAIDs, ETOH during MTX. Repeat dose if β-hCG fails to drop ≥15% on day 4 to 7.
Outcome
Surgical management — salpingectomy if rupture/large/recurrent; salpingostomy preserves tube
Outcome
Confirmed IUP — investigate other causes of bleeding
Decision
β-hCG level (non-diagnostic US)?
✓
>1500 IU/L (discriminatory zone) + no IUP → likely ectopic
✓
<1500 IU/L → repeat β-hCG in 48 h and US
Outcome
Repeat β-hCG in 48 h: normal IUP doubles ~q48h
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