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Guidance on MTX treatment

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ACEC
Posts: 1
Joined: Sat Jul 30, 2022 1:26 pm

Guidance on MTX treatment

Post by ACEC »

My partner was recently diagnosed with an ectopic pregnancy and we're looking for some guidance on how to approach dealing with the NHS and increasing our confidence in the decisions we might need to make.

After some light spotting in W5 we arranged a private ultrasound to ensure everything was proceeding normally. GP told us not to worry about the spotting but thankfully we did as the scan at W6D6 suggested an ectopic. We were rushed to A&E where blood test showed β-hCG levels around 4000. Wife was admitted and eventually given methotrexate about 24 hours after arriving at A&E. However, it doesn't seem as if any other blood tests were done in those 24 hours or immediately prior to MTX injection.

The hospital has brought us in for follow-up blood tests but doesn't seem to be following the usual day 0, day 4, day 7 schedule.

I can't tell whether this is a conscious choice or if they are getting mixed up with the blood draw dates and the MTX treatment date. I understand that the days are somewhat arbitrary, but if we are going to be recommended surgery at the start of day 5 post MTX we are nervous that the medication hasn't been given sufficient time to work.
  • Monday evening (day -1) - ultrasound suggests gestational sac 2cm in size in right fallopian, blood β-hCG 4000
  • Tuesday evening (day 0) - MTX administered, no further bloodwork carried out, no bleeding or blood pressure issues
  • Friday morning (day 3, but really only about 66 hours post MTX, rather than expected 96) - β-hCG 7800 (a significant step up!). Ultrasound shows no change to sac.
We've been asked to come in on Sunday morning (day 5, 110 hours post MTX) for a follow-up blood and ultrasound, but told nil-by-mouth and prepare ourselves that surgery may be required.


A few questions for the forum:
  • Am I calculating the days post-MTX correctly?
  • Is it strange that the hospital isn't following the typical routine?
  • Would we be out of our minds to push to wait until day 7 before making any decisions about surgery? Can we even do this in the NHS?
We do understand the day 3 β-hCG is high, but its unclear how important this is relative to the other factors and the weird timeline/

books+brioche
Posts: 2
Joined: Thu Jul 28, 2022 5:53 pm

Re: Guidance on MTX treatment

Post by books+brioche »

The day methotrexate is administered is actually considered Day 1 rather than Day 0 (not intuitive, I agree!). So her first follow-up was done on the correct day (Day 4) but her second appointment does seem to be scheduled 1 day early (Day 6 rather than 7). I would ask your provider the reason for this.

Wishing you and your partner all the best.

EPT Host 20
Posts: 3155
Joined: Thu May 31, 2012 10:58 pm

Re: Guidance on MTX treatment

Post by EPT Host 20 »

Dear ACEC,
I am so sorry to hear of your ectopic pregnancy and loss

Day 1 is usually the day the injections are given and they should be keeping a close eye on bloods, day 4 and day 7 should follow.
Day 4 bloods normally rise as the action of methotrexate is not instantaneous.
I have added more information on methotrexate from our website here and I hope this helps with further information.

https://ectopic.org.uk/treating-an-ecto ... thotrexate

Sending much love,
Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811
Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards
Join us for the first Ectopic Pregnancy Awareness Day on 1 August 2022

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dodonnell92
Posts: 9
Joined: Mon Jul 11, 2022 8:37 pm

Re: Guidance on MTX treatment

Post by dodonnell92 »

Hey!
I’m so sorry you’re going through this.
I had a methotrexate injection last month as I had a PUL. My HcG levels had increased on day 4 and had only dropped by 1 on day 7. I asked to wait to have another blood test on day 10 instead of opting for a second injection or surgery which they allowed. By day 10 my HcG had dropped by 42% and have since dropped to 10 in the last week.
My levels were significantly lower than yours though so I’m not sure they will allow this but I’m so glad I stuck to my guns.
Hope you’re both doing ok.
Debbie x

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