A 28-year-old woman with previous PID presents with 7 weeks of amenorrhea, vaginal bleeding, and left iliac fossa pain. Serum β-hCG is 2800 mIU/mL. Transvaginal ultrasound shows no intrauterine gestational sac and a 2.5 cm adnexal mass with a ring of fire sign on Doppler. She is hemodynamically stable. The MOST appropriate first-line management is:
- A Laparoscopic salpingectomy
- B Expectant management with weekly β-hCG monitoring
- C Single-dose methotrexate 50 mg/m² IM ✓
- D Repeat ultrasound in 48 hours to confirm
Correct answer: C. Single-dose methotrexate 50 mg/m² IM
Explanation
This patient meets criteria for medical management of ectopic pregnancy: hemodynamically stable, adnexal mass <3.5 cm, unruptured, no cardiac activity on ultrasound, and β-hCG <5000 mIU/mL. Single-dose methotrexate 50 mg/m² IM is the recommended first-line treatment. Laparoscopic salpingectomy is indicated for rupture, hemodynamic instability, β-hCG >5000, or failed methotrexate. The diagnosis is sufficiently established (ring of fire sign, no IUP at β-hCG above the discriminatory zone) to proceed with treatment.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.