A 33-year-old woman reports eight weeks of intermittent dull right pelvic pain. Examination shows mild right adnexal fullness with minimal tenderness. Beta-hCG is 115 mIU/mL and transvaginal ultrasound shows a 2 cm heterogeneous right adnexal mass with no significant vascularity and no free fluid. Which statement about her condition is correct?

• A This is an acutely ruptured ectopic requiring immediate laparotomy
• B Serial beta-hCG measurement alone is sufficient, as resolution is universal
• C Single-dose methotrexate is highly effective and is the first-line treatment
• D This is a chronic ectopic pregnancy, and surgical excision is the appropriate treatment because the trophoblast is largely inactive ✓

Explanation

A chronic ectopic results from repeated small leaks of blood from the tube that organise into a haematocele, producing a pelvic mass with low, often plateauing beta-hCG and little vascularity because trophoblast is inactive. Medical treatment with methotrexate targets actively dividing trophoblast and therefore works poorly here, making surgery the mainstay. Free fluid and peritonism are absent, excluding acute rupture.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.