How can I effectively counsel a patient diagnosed with ectopic pregnancy regarding their treatment options and potential outcomes?

Explain to the patient that an ectopic pregnancy is a pregnancy that occurs outside the uterus, most commonly in the fallopian tubes, and that it requires prompt management to prevent complications ¹.

Discuss the available treatment options, including expectant management (watchful waiting) for women who are stable, pain-free, and meet specific criteria such as small size of the ectopic (<35 mm) and low serum hCG levels (≤1500 IU/L) ¹.

Describe medical management with methotrexate, which is suitable for women with no significant pain, unruptured ectopic, small adnexal mass, no visible heartbeat, and serum hCG less than 1500 IU/L, who can return for follow-up ¹.

Explain surgical options, such as salpingectomy or salpingotomy, which are indicated for women with significant pain, larger masses, visible fetal heartbeat, or higher serum hCG levels, and that surgery is usually performed laparoscopically ¹.

Inform the patient about the potential outcomes, including the possibility of resolution without further intervention with expectant management, or the need for additional treatment if initial management fails ¹.

Emphasize that all treatment options aim to resolve the pregnancy safely and preserve future fertility where possible, and that the choice depends on clinical stability, pregnancy characteristics, and patient preferences ¹.

Advise her about the importance of follow-up, including serial hCG measurements, and the need for contraception for at least 3 months if treated with methotrexate, due to its teratogenic effects ¹.

Finally, offer psychological support and discuss access to support groups, as pregnancy loss can have significant emotional impacts, and reassure her that support is available ¹.

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