Going to Great Pains

Protocol for Medical treatment (Methotrexate) of Ectopic Pregnancy. Written by The Royal Oldham Hospital. Revised March 2001

Advantages:
Good success rates (More than 90%) in appropriately selected cases
Comparable to conservative surgery in terms of subsequent fertility
General anaesthetic avoided

Disadvantages:
Risk of toxicity: nausea, stomatitis, bone marrow suppression, pneumonitis, elevated liver enzymes
Repeated visits to ensure resolution of pregnancy

Selection criteria:
Clinically stable
Able and willing to attend for follow-up scans and blood tests
Early unruptured ectopic pregnancy
Under 8 weeks gestation
No free fluid on ultrasound scan
Ectopic sac <3cm>

Management:
Discuss with consultant
Counsel patient, obtain consent and give information on medical treatment of ectopic pregnancy
Blood tests:
FBC,
Group & save serum,
U& E,
LFT
hCG
Prescribe a single dose of intramuscular Methotrexate 50 (fifty) mg
(if weight is <50kg, prescribe 1mg/kg)

Discharge with following advice:
Avoid sexual intercourse
Avoid alcohol
Avoid folic acid
Ectopic may rupture.
To come back in immediately if feeling dizzy or exacerbated abdominal pain Avoid conception for 3 months

Follow-up:
Twice weekly hCG until falling, then weekly until <10iu/1
If hCG not falling, request ultrasound scan If no significant fall in hCG after 7 days, then consider either repeat methotrexate or surgical treatment (discuss with patient)

Note: hCG may fall slowly. Median time to resolution is 1 month Discuss contraception



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I was at work when I got the call yesterday from RE's nurse that my b/w results came back surprising (Note: RE hasn't seen this happen before). My hCG levels rose from 239 last week to 330 yesterday. Went back to RE for u/s which showed a significant change in the size of the cyst and halo of fluid ~ they were both barely noticeable. As RE put it, "don't want to put the cart before the horse", so I was advised to come back on Monday for more b/w and if the levels are still steadily increasing, I'm to get laparoscopic surgery to remove my right fallopian tube on Thursday (3/26).

Not to sound gruesome, but I have constipation...it has only been worse since I was injected the 2nd time with the demon Methotrexate a few weeks ago. Last night, when I went to the bathroom to pee before bed, my lower body was in total distress. I never felt it coming and then all of a sudden, I was suffering...hardcore. I turned white as a ghost and almost fainted a few times from the unbearable torture in my abdomen...not necessarily from my intestines, but the muscles too. I've never felt anything so excruciating in my life. I've had horrid constipation symptoms before, this fuckin' hurt a million times more. I could barely lift myself from the toilet for fear that the pain would get worse, laid my exhausted body on the bed, and writhed in agony. My husband totally freaked out ~ kept asking me if I should go to the hospital. All I wanted to do was sleep. I took some extra-strength tylenol, my husband rubbed my head, and I felt my body relax. Thankfully, the pain subsided enough that I was able to sleep through the night.

My reason for writing about this incident is that I've really been OK for the last 2 weeks. I've been feeling healthier except for the constipation on and off, and was starting to feel like my life was getting back on track. Then, I get the phone call at work yesterday that my hCG is rising, feel my heart skip a beat, anticipate surgery that day, am told to wait until Monday to determine the outcome, and then writhe in pain that evening. Coincidence? I think not.

It's official. god hates me.