A 32-year-old woman has an interstitial (cornual) ectopic pregnancy at 8 weeks. β-hCG is 12,000 mIU/mL and she is hemodynamically stable. The BEST initial management is:

• A Systemic multi-dose methotrexate protocol ✓
• B Laparoscopic cornuotomy
• C Expectant management with twice-weekly β-hCG
• D Hysterectomy to prevent catastrophic rupture

Explanation

Interstitial ectopic pregnancy carries high rupture risk and potentially fatal hemorrhage due to myometrial support delaying rupture until larger size. When hemodynamically stable, multi-dose methotrexate (protocol with leucovorin rescue) is the preferred initial management because of high vascularity making surgical approaches hazardous and risk of cornual resection compromising uterine integrity. β-hCG of 12,000 exceeds single-dose criteria; multi-dose protocols are preferred for interstitial ectopics even at higher levels when stable.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.