In which of the following conditions a medical treatment of ectopic pregnancy contraindicated?: (A) Sac size is 3 cm, (B) 50 mL free fluid in pelvis, (C) Presence of foetal hea activity, (D) Previous ectopic pregnancy
Answer is C. Medical management (methotrexate) is the treatment of choice for an ectopic pregnancy whenever the required criteria are fulfilled- Patient should be hemodynamically stable (unruptured tubal ectopic pregnancy). Foetal cardiac activity absent (presence of cardiac activity is a relative contraindication). b-hCG levels <5,000 mIU/mL (levels > 5,000 micro IU/mL is a relative contraindication). Gestational sac diameter <4 cm. Free fluid in POD <100 mL.