A 26-year-old presents with 7 weeks amenorrhoea, mild left pelvic pain, and a serum β-hCG of 2,200 mIU/mL with an empty uterus on transvaginal ultrasound. The adnexa are not visualised. She is haemodynamically stable. According to ACOG criteria, which best guides the decision to administer methotrexate?
- A Absence of a gestational sac on ultrasound, haemodynamic stability, no contraindications, and willingness to comply with follow-up ✓
- B Serum β-hCG < 5,000 mIU/mL is the only criterion needed for single-dose methotrexate
- C β-hCG doubling time < 48 hours confirms ectopic and mandates methotrexate over expectant management
- D Absence of cardiac activity in adnexa confirms suitability for methotrexate
Explanation
ACOG criteria for methotrexate eligibility in suspected ectopic pregnancy include: haemodynamic stability, no evidence of intrauterine pregnancy (no gestational sac in uterus), no contraindications (renal/hepatic disease, thrombocytopenia, immunodeficiency, active pulmonary disease, breastfeeding), ability to comply with follow-up. β-hCG < 5,000 mIU/mL predicts better success rates with single-dose MTX but is a prognostic rather than eligibility criterion. Cardiac activity in the adnexa is a relative contraindication to MTX (single-dose protocol). The presence of embryonic cardiac motion typically favours surgical management.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.