A 27-year-old primigravida is diagnosed with ectopic pregnancy at 6 weeks gestation. Her serum hCG is 1,800 IU/L, she is haemodynamically stable, and transvaginal ultrasound shows a 2.5 cm adnexal mass with no fetal cardiac activity and no free fluid in the pouch of Douglas. The MOST appropriate management is:

• A Emergency laparotomy with salpingectomy
• B Expectant management with serial hCG monitoring
• C Laparoscopic salpingostomy
• D Single-dose intramuscular methotrexate ✓

Explanation

Methotrexate (single dose, 50 mg/m² IM) is appropriate for haemodynamically stable ectopic pregnancies meeting specific criteria: hCG <5,000 IU/L, no fetal cardiac activity, adnexal mass ≤3.5–4 cm, no free fluid indicating rupture, and patient compliance for follow-up. This patient meets all criteria. Surgical management is reserved for haemodynamic instability, failed medical therapy, or contraindications to methotrexate.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.