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Dr. C.
Dr. C., Board Certified
Category: OB GYN
Satisfied Customers: 3064
Experience:  30 yrs experience, awarding winning educator
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I have been diagnosed with ectopic pregnancy - on 25th

Customer Question

hi, I have been diagnosed with ectopic pregnancy - on 25th June, my hcg was 1010, and they gave me methotextrate 70 mg on 26th June. On july 2, my hcg is 605. Do i need another dose of methotextrate or can I wait?
Submitted: 2 years ago.
Category: OB GYN
Expert:  Dr. C. replied 2 years ago.
Hi, This is Dr. C. Board certified Ob-gyne with 30+ years of experience. I'm sorry that you're having to deal with this. There are very specific guidelines on this. It requires some math so I will get my calculator and do some. It would also be helpful if you gave me your height and weight so I can verify that your dose of methotrexate was correct. After methotrexate, the guidelines recommend checking the beta=HCG levels on day 4 and 7 post injection. Unfortunately, your beta-HCGs are from 1 day pre-injection and day 6. So we'll have to estimate. The guidelines state that there needs to be a 15% drop in beta-HCG level from day 4 to day 7 post-injection. You had a 40% decrease from 1 day pre-injection to 6 days post-injection. Often the beta-HCG goes up first before dropping, so sometimes it's higher on day 4. So overall it seems that you've had a pretty good response. I'm sorry that your doctors didn't draw the beta-HCGs on the recommended days. That would definitely make it easier to tell you based on research evidence whether another dose was needed or not. But rough estimates makes me think you're ok. Are there any other beta-HCG values that were drawn? If so, what days and numbers? Are there any other draws planned? There certainly should be. I've attached the practice guideline for methotrexate management of ectopic pregnancy for you. Let me know if this attachment doesn't work. I hope this information was helpful.
Customer: replied 2 years ago.
I am sorry, I mis-wrote! It was 817 day before injection and went to 605 on day 6. My height is 5'2" and I weigh 70 kilos. So, they gave me 70mg of methotrexate. So, it has dropped by 25%, is that good enough? Does it mean I don't need any additional dose of methotrexate ?
Many thanks!
Expert:  Dr. C. replied 2 years ago.
Yes that's plenty dose for your body surface area, so methotrexate was adequate. Since I'm in the US, I use the American College of Ob-Gyne Practice Bulletin guidelines to figure out if the drop was adequate. From day 4 to day 7 post-injection, it needs to drop by 15%. So I have no research based way to be certain that your 25+% drop from 1 day before injection to day 6 was adequate for sure, but it seems reasonable. The beta-HCG should be rechecked at reasonable intervals to be sure it doesn't start to climb again. I personally would want 1 or 2 more measurements at 2-3 day intervals before resting easy that another dose wasn't needed. There should never be a rise again. I hope this was helpful. Anything else?
Customer: replied 2 years ago.
Ok, perfect! Thanks. I will get the numbers checked regularly in the next few days and share them with you. Is that possible or do I need to re-pay to contact you ?
Expert:  Dr. C. replied 2 years ago.
That would be considered a follow-up question so can go into this same thread without additional payment. So go ahead and leave a feedback rating today for my service but then use the same thread to post the follow-up numbers for me to review. Follow-up is included in the original post.
Dr. C. and other OB GYN Specialists are ready to help you
Customer: replied 2 years ago.
Hi again, I have got another blood test result - my blood hcg has gone to 312, down from 605 on 2nd July, and today is 6 July. What is the protocol now - how frequently do I need to get my blood levels checked?TIA
Expert:  Dr. C. replied 2 years ago.
Excellent. Probably one more in 3-4 days, then weekly until negative test is obtained. But if your doc wanted to move to weekly now, that would be reasonable. Glad it seems to have worked.
Customer: replied 2 years ago.
Thanks!! I have plans to travel by plane on the 15th, and my size of the tissue is 1.1mm - is it safe to travel by plane ? Or jerks can be risky?
Expert:  Dr. C. replied 2 years ago.
If the tissue is at 1.1mm, that is VERY little. Seems like it should be perfectly safe to travel at this point. But it's best to check in with the doctor managing your ectopic just in case. Good luck and happy travels.
Customer: replied 2 years ago.
Thanks!!
Expert:  Dr. C. replied 2 years ago.
You're welcome. Have a great trip and fast recovery.