Ectopic Pregnancy

A 32-year-old woman with a history of pelvic inflammatory disease presents with amenorrhea and mild lower abdominal pain. Serum β-hCG is 1200 mIU/mL. Transvaginal ultrasound shows no intrauterine gestational sac, but a 2 cm echoic mass is seen in the right fallopian tube with a live fetal pole and cardiac activity. Which feature best distinguishes a tubal ectopic pregnancy from a cornual ectopic pregnancy?

A 28-year-old woman presents with 6 weeks of amenorrhea, right lower abdominal pain, and vaginal spotting. Transvaginal ultrasound shows an empty uterus with a 3.5 cm mass in the right adnexa. β-hCG is 8,500 mIU/mL. She is hemodynamically stable with no signs of rupture. What is the drug of choice for medical management of this ectopic pregnancy?

A 32-year-old woman with a history of pelvic inflammatory disease presents with 8 weeks of amenorrhea and right-sided abdominal pain. Transvaginal ultrasound reveals a 2.8 cm gestational sac with a yolk sac in the right fallopian tube. β-hCG is 3,200 mIU/mL. She is hemodynamically stable. Which drug is the first-line pharmacologic treatment for this tubal ectopic pregnancy?

A 28-year-old woman presents to the emergency department with acute lower abdominal pain and vaginal spotting for 2 days. She reports a missed period 6 weeks ago. Vital signs: BP 100/65 mmHg, HR 110/min, RR 20/min. On examination, she has severe left lower quadrant tenderness with guarding. Urine pregnancy test is positive. Transvaginal ultrasound shows an empty uterine cavity with free fluid in the pelvis. Serum β-hCG is 8,500 mIU/mL. What is the most appropriate next step in management?

A 32-year-old woman (G3P2) with a history of pelvic inflammatory disease 2 years ago presents with 8 weeks of amenorrhea and mild lower abdominal discomfort. Vital signs are stable (BP 118/76 mmHg, HR 82/min). Serum β-hCG is 6,200 mIU/mL. Transvaginal ultrasound shows an empty uterine cavity and a 2.5 cm gestational sac-like structure in the left fallopian tube with yolk sac but no fetal pole. There is minimal free fluid in the pelvis. What is the most appropriate management?