Introduction
unruptured ectopic pregnancy, rupture
ECTOPIC PREGNANCY, RUPTURED ECTOPIC PREGNANCY
Ectopic pregnancies are a leading cause of first trimester maternal morbidity and mortality and complicate approximately 2% of all pregnancies (Methotrexate, an anti-folate cytotoxic drug, is an established, safe medical treatment for unruptured ectopic pregnancy that allows many haemodynamically stable women to avoid surgery. However, 29% of those treated with single-dose methotrexate will experience treatment failure, requiring rescue surgery (Current UK guidelines advise that serum hCG is measured on Day 4 and Day 7 post-methotrexate treatment because a >15% reduction in hCG levels in this period indicates likely treatment success. Patients with ≤15% reduction in hCG levels are considered for further methotrexate treatment and/or surgery (Stovall’s protocol does not predict response earlier than 7 days post-methotrexate treatment. The advantages of even earlier prognostic information are numerous: earlier identification of likely methotrexate treatment failure allows for the option of earlier surgical intervention, which would then reduce the risk of rupture. Earlier prognostic information also provides earlier reassurance and reduces the follow-up burden for those involved in what can be a distressing and uncertain time (Utilizing prospectively collected data from a large UK ectopic pregnancy clinical trial cohort (