Could Methotrexate Be an Option for Managing Ectopic Pregnancies in Women With an Initial High β-Human Chorionic Gonadotropin Level?

Ectopic pregnancy is a common clinical problem with a formal evidence-based practice guideline. In this case, the patient declined the recommended standard management following counselling. In this report, we present the case management, time to resolution, and patient perspective for refusal of standard treatment. We reviewed the recommendations of the National Institute for Health and Care Excellence (NICE) and American College of Obstetricians and Gynecologists (ACOG) guidelines with the supporting evidence, along with other published studies evaluating the effectiveness of methotrexate with varying initial levels of β-human chorionic gonadotropin (β-hCG). Informed patient choice, as a part of modern medical practice, is addressed with reference to novel practices in obstetrics. We questioned whether methotrexate could be an option for these women following thorough counselling. The significance of a persistent ectopic mass after clinical resolution is highlighted as an area that requires further research to evaluate the benefits and risks of this treatment option.