Diagnosed Tubal Ectopic Pregnancy in Obstetrics & Gynecology — Case | General Gynecology | SMLE Q#446

SMLE Question #446

Obstetrics & Gynecology General Gynecology
Last updated: February 2026
A 26-year-old G2P0 woman with a diagnosed tubal ectopic pregnancy received single-dose intramuscular methotrexate as an outpatient 7 days ago. She returns for scheduled monitoring. She has mild, unchanged pelvic discomfort and no vaginal bleeding, dizziness, or syncope. Abdominal examination shows mild adnexal tenderness without guarding or rebound. Transvaginal ultrasound shows a small unruptured adnexal ectopic pregnancy with no free intraperitoneal fluid. Serial serum β-hCG values are documented. What is the most appropriate next step in management?

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