A 28-year-old presents with 7 weeks amenorrhoea, mild right iliac fossa pain, and vaginal spotting. Serum β-hCG is 2400 mIU/mL. Transvaginal ultrasound shows no intrauterine gestational sac; an adnexal mass with a ring-of-fire appearance is seen. The most appropriate management is:
- A Methotrexate 50 mg/m² IM single-dose regimen ✓
- B Expectant management with serial β-hCG monitoring
- C Emergency laparotomy with salpingectomy
- D Repeat β-hCG in 48 hours and rescan if stable
Correct answer: A. Methotrexate 50 mg/m² IM single-dose regimen
Explanation
The 'ring of fire' sign (hypervascular ring in the adnexa on colour Doppler) with no IUP and β-hCG 2400 mIU/mL confirms ectopic pregnancy. With haemodynamic stability, unruptured ectopic, no contraindications (normal renal/hepatic function, no ascites, hCG <5000 mIU/mL typically), medical management with single-dose IM methotrexate (50 mg/m²) is appropriate and avoids surgery. Expectant management requires a declining hCG; a definite adnexal mass with ring of fire sign warrants treatment. Emergency surgery is for haemodynamically unstable or ruptured ectopic.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.