Decisions, decisions

Labs came back not so hot - hcg is still slowly rising, but definitely not enough to indicate a good pregnancy. 1300-something on Monday and 1600 yesterday :(

Here are my current options:

1) Do nothing - risking tubal rupture if it is ectopic

2) Methotrexate - today or Monday - which would be appropriate treatment for ectopic, but might not get rid of uterine pregnancy tissue. Would need weekly hcgs until negative.

3) D&C - would obviously get rid of any uterine tissue, but would not deal with possibly ectopic - so could need methotrexate afterwards if hcg continues to stay elevated after the surgery.

2) Go in Monday for another sono to try one more time to determine uterine or tubal pregnancy - and then make treatment decision.

While I wish I could consider it, doing nothing seems irresponsible. I would be devastated to lose my tube and a ruptured ectopic is a true medical emergency.

Complicating matters is the travel plans we have to leave for MN on Thursday. Scheduling surgery prior to our trip is seeming unlikely.

I called for a second opinion from my RE, although when I spoke with him on Tuesday he said he was going out of town for Spring Break, so he may be gone already - and will definitely be gone next week. My midwife was going to talk to the doctor on call at my OB's office and call me back with his opinion.

I feel like I'm doing everything I can. My initial reaction is to wait until Monday for one more sonogram. If, after that, things are still inconclusive, then I'm leaning towards the methotrexate. I have already had 3 uterine surgeries in the last 3 1/2 years (C-Section 8/04, D&C 3/06 and hysteroscopy 12/06). I *really* want to avoid another if at all possible.

Any ideas?