A 26-year-old woman presents with a presumed ectopic pregnancy. She is asymptomatic and hemodynamically stable, with a serum β-hCG of 350 mIU/mL that is declining. Transvaginal ultrasound shows a 1.5 cm unruptured adnexal mass. Which of the following best describes the appropriate next step?

• A Immediate single-dose methotrexate
• B Diagnostic dilation and curettage
• C Laparoscopic salpingostomy
• D Expectant management with serial β-hCG ✓

Explanation

Expectant management is indicated for small, unruptured ectopic pregnancies in asymptomatic patients with declining β-hCG levels. Methotrexate is used for stable patients with higher, unruptured masses. Surgery is for rupture or failed medical therapy. Dilation and curettage is used to differentiate failing intrauterine pregnancy from ectopic, not for a visualized adnexal mass.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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