A 25-year-old woman is diagnosed with an unruptured ectopic pregnancy. She is hemodynamically stable, has minimal symptoms, and serum β-hCG is 800 mIU/mL and declining on repeat testing 48 hours later. Which of the following best describes the next step in management?

• A Proceed with single-dose methotrexate
• B Continue expectant management with serial β-hCG monitoring ✓
• C Perform laparoscopic salpingostomy
• D Administer two doses of methotrexate 48 hours apart

Explanation

Expectant management is appropriate when the ectopic is unruptured, the patient is stable, and β-hCG is low (<1000-1500 mIU/mL) with documented spontaneous decline. Methotrexate is reserved for stable patients with rising or plateaued hCG below surgical thresholds. Surgery is indicated if the patient becomes unstable, hCG rises, or symptoms worsen. The declining hCG indicates the pregnancy is already resolving.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.