A 24-year-old woman presents at 6 weeks amenorrhea with mild right-sided pelvic pain. She is hemodynamically stable. Transvaginal ultrasound shows an empty uterus, a 1.5 cm heterogeneous right adnexal mass, and no significant free fluid. Serum β-hCG is 850 mIU/mL. Repeat β-hCG after 48 hours is 780 mIU/mL. She is reliable for follow-up. What is the most appropriate management?
- A Single-dose methotrexate 50 mg/m² intramuscularly
- B Laparoscopic salpingostomy
- C Expectant management with serial β-hCG monitoring ✓
- D Uterine curettage to exclude spontaneous abortion
Correct answer: C. Expectant management with serial β-hCG monitoring
Explanation
Expectant management is appropriate for small unruptured ectopic pregnancies when serum β-hCG is low and declining spontaneously, the patient is hemodynamically stable, and reliable follow-up is assured. A falling hCG indicates tubal resolution is occurring without intervention. Methotrexate is reserved for patients with rising or plateaued hCG levels, and surgery is indicated for instability, larger masses, or failed medical therapy.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.