Management of separation pain after single-dose methotrexate therapy for ectopic pregnancy

Objective: To review the success of conservative management of moderate to severe abdominal/pelvic pain occurring after treatment of ectopic pregnancy with systemic methotrexate, to evaluate prognostic factors for success, and to determine if the overall resolution time was shorter in such patients.Methods: A retrospective chart review of all single-dose methotrexate patients treated from January 1, 1992 to January 1, 1997 who were admitted for observation or evaluated and subsequently discharged after an episode of increased abdominal/pelvic pain unrelieved within 1 hour by 800 mg oral ibuprofen. Before 1992, patients developing such pain generally underwent surgery. Candidates for conservative management were hemodynamically stable and had no more than moderate (confined to the pelvis) free fluid. Mild rebound was not an exclusion. Hospitalized patients had serial abdominal examinations, hematocrits, and hCG titers. Hematocrits, ultrasound findings, hCG levels, time for hCG levels to reach