Clinical Review
Pregnant Woman, 39, With Hypertension and New-Onset Proteinuria
In pregnant patients, elevated liver enzymes may indicate one of several serious conditions; which one is affecting this patient, and how would...
FOLLOW-UP AND REFERRALS
Close monitoring of ß-hCG levels, as described previously, is essential after methotrexate treatment in order to confirm that the pregnancy has been terminated and reduce the risk for tubal rupture. Clinicians should also be sensitive to the sequelae of loss of a pregnancy and refer patients as needed to appropriate health care professionals for grief support.
CASE The patient was referred to an obstetrics clinic and reported for all scheduled follow-up appointments. She was discharged from care after a full reduction in her ß-hCG to nonpregnant levels. While at the clinic, the patient was referred to social services for psychosocial counseling.
CONCLUSION
Ectopic implantation is a serious complication that may occur during the first trimester of pregnancy. Worldwide, it is the leading cause of maternal death in the first trimester. For women who meet specific criteria, outpatient treatment of early ectopic pregnancy with methotrexate avoids surgery and decreases the overall cost of care. Medical management and conservative surgical management offer the patient comparable outcomes for tubal patency preservation and risk for ectopic pregnancy recurrence.11
REFERENCES
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9. Hajenius PJ, Mol F, Mol BW, et al. Interventions for tubal ectopic pregnancy. Cochrane Database Syst Rev. 2007;(1):CD000324.
10. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115(3): 495-502.
11. Autry A. Medical treatment of ectopic pregnancy: is there something new? Obstet Gynecol. 2013;122(4):733.
12. The Practice Committee of the American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy: a committee opinion. Fertil Steril. 2013;100(3):638-644.
