A haemodynamically stable woman with a 2.8 cm right tubal ectopic pregnancy and serum β-hCG of 1,800 IU/L desires future fertility. No cardiac activity is seen on transvaginal ultrasound. The MOST appropriate management is:

• A Immediate salpingectomy via laparoscopy
• B Two-dose methotrexate protocol
• C Expectant management with serial β-hCG monitoring
• D Single-dose methotrexate 50 mg/m² IM ✓

Explanation

Single-dose methotrexate (50 mg/m² IM) is the treatment of choice for haemodynamically stable, unruptured ectopic pregnancy when β-hCG is <5,000 IU/L, there is no fetal cardiac activity, and the ectopic is <3.5 cm. Success rates exceed 85% with single dose at this β-hCG level. Criteria for MTX: no cardiac activity, size <3.5 cm, β-hCG ideally <5,000 IU/L, normal renal/liver/CBC. Salpingectomy is reserved for failure, rupture, or contraindications to MTX.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.