Medical management of ectopic pregnancy with extremely high beta-HCG levels: a case report

We report the successful treatment of an unruptured ectopic pregnancy in a patient with extremely high beta-human chorionic gonadotropin concentrations. A 33-year-old woman, gravida 2, para 0, abortus 1, presented to our department due to menstrual delay. On transvaginal ultrasonography, she had an unruptured ectopic pregnancy (3.5 x 4.5 cm). Her initial beta-HCG concentration was 38,270 mIU/ml. The administration of methotrexate (50 mg/m2) was performed intramuscularly. Serum beta-HCG levels decreased > 15% between post-therapy days 4 (31,324 mIU/ml) and 7 (13,108 mIU/ml), and did not rise during the subsequent weekly controls. In selected cases with unruptured ectopic pregnancy and extremely high initial beta-HCG levels, medical management with a single-dose methotrexate regimen may be successful.