Answer 4:

In the Emergency Room:

-- Secure IV access. -- Volume resuscitation to assure hemodynamic stability. Note, these patients are young and usually otherwise healthy. There may be compensation for dramatic blood losses so patients may not appear to be in shock until it is too late.

Definitive management:

--Surgery ASAP. Usually performed laparoscopically. Salpingotomy preferred to salpingectomy if technically feasible. If very early in gestation OBS/GYN may use systemic methotrexate (MTX). This therapy is indicated only in hemodynamically stable patients with an unruptured mass less than 4 cm in diameter. Patients with ectopic pregnancies with larger masses, cardiac activity in the adnexa or evidence of acute intraabdominal bleeding are ineligible for MTX therapy. {Ref. Carson SA, Buster JE. Ectopic pregnancy. N Engl J Med 1193- 329:1174-81}