[50.1] A 28-year-old woman has been given ovulation induction agents of human menopausal gonadotropin (follicle-stimulating hormone and luteinizing hormone) and becomes pregnant. On sonography, she is noted to have a viable intrauterine pregnancy as well as a pregnancy with fetal cardiac activity in the adnexa. Which of the following is the best therapy?
A. Intramuscular methotrexate
B. Oral methotrexate
C. Surgical therapy
D. Mifepristone (RU 486)
150.21 A 22-year-old woman is diagnosed with an ectopic pregnancy based on hCG levels, which have plateaued at 2900 mlU/mL, and an endometrial biopsy showing no chorionic villi. In reviewing the therapy options with the patient, the physician explains the mechanisms of action of methotrexate. Which of the following statements about methotrexate is correct?
A. It interferes with mitosis phase of the cell cycle.
B. It is obtained from the bark of the Pacific yew tree.
C. It severs DNA strands between particular base pairs.
D. It interferes with folate synthesis and DNA synthesis.
E. It causes pulmonary fibrosis in approximately 5% of patients.
[50.3] A 22-year-old woman is given intramuscular methotrexate for a proven ectopic pregnancy. On the fourth day after therapy, she experiences crampy lower abdominal pain. Her blood pressure and heart rate are normal. Abdominal examination is unremarkable. Transvaginal ultrasound examination shows no free fluid. Which of the following is the best next step?
A. Immediate laparoscopy
B. Immediate exploratory laparotomy
D. Institution of folic acid
[50.4] A 25-year-old G1 P0 woman at 5 weeks' gestation receives oral mifepristone (RU 486) and 2 days later receives oral misoprostol (Cytotec). The next day, she has vaginal bleeding and passage of tissue. She comes into the emergency room because of persistent cramping and vaginal bleeding. The tissue has a frondlike, floating appearance in saline. Her cervical os is open. Which of the following is the most likely diagnosis?
A. Incomplete abortion
B. Ectopic pregnancy
C. Molar pregnancy
E. Completed abortion
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