A 24-year-old woman has an unruptured ectopic pregnancy at 6 weeks, confirmed by transvaginal ultrasound showing a 2.8 cm adnexal mass with cardiac activity. She is haemodynamically stable. Serum beta-hCG is 4,200 mIU/mL. She has no contraindications to methotrexate. Which of the following is a contraindication to medical management with methotrexate in this case?
- A Serum beta-hCG >2000 mIU/mL
- B Adnexal mass size of 2.8 cm
- C Fetal cardiac activity present on ultrasound ✓
- D Gestational age of 6 weeks
Correct answer: C. Fetal cardiac activity present on ultrasound
Explanation
Presence of fetal cardiac activity (embryonic cardiac motion) in an ectopic pregnancy is a relative-to-absolute contraindication to methotrexate therapy because it significantly reduces treatment success rates and increases the risk of rupture requiring surgical rescue. ACOG lists cardiac activity as a contraindication to single-dose methotrexate protocol. hCG >5,000 mIU/mL, adnexal mass >3.5 cm, and haemodynamic instability are other contraindications; hCG >2,000 alone is not an absolute contraindication.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.