Management options:
(1) surgery
(2) methotrexate
(3) expectant management
Surgery is indicated if one or more of the following is present:
(1) there are signs of tubal rupture
(2) the serum beta-HCG is > 5,000 IU/L
(3) laparoscopy is required to make the diagnosis
(4) a heterotopic pregnancy is suspected
(5) patient is unlikely to adhere to long-term surveillance
Expectant management (watchful waiting) is indicated if all of the following are present:
(1) there is no evidence of tubal rupture
(2) the serum beta-HCG is < 1,500 IU/L
(3) the serum beta-HCG is declining at 48 hours
(4) the patient understands the need for ongoing surveillance
(5) the patient is in close proximity to adequate medical services throughout the followup period
If (a) neither surgery nor expectant management is indicated, or (b) if there is progression during expectant therapy, then methotrexate therapy should be used.
