Regarding methotrexate (MTX) treatment for ectopic pregnancy using the single-dose protocol, which criterion is correctly defined as a contraindication to medical management?
- A Initial beta-hCG level between 1500-3000 mIU/mL
- B Fetal cardiac activity on transvaginal ultrasound ✓
- C Adnexal mass measuring 2.8 cm with no cardiac activity
- D Mild pelvic tenderness without peritoneal signs
Explanation
Presence of fetal cardiac activity on TVS is a contraindication to MTX medical treatment for ectopic pregnancy, as success rates drop to <25% and risk of treatment failure with tubal rupture increases significantly. Other contraindications include: hemoperitoneum, hemodynamic instability, immunodeficiency, liver/renal disease, blood dyscrasias, intrauterine pregnancy, and inability to comply with follow-up. Adnexal mass >4 cm (not 2.8 cm) is considered a relative contraindication by ACOG (mass >3.5 cm by some guidelines). Initial hCG 1500-3000 mIU/mL is within acceptable range for single-dose MTX. ACOG 2018 recommends MTX when hCG <5000 mIU/mL and no cardiac activity.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.