**Question:** Management of unruptured tubal pregnancy includes:

Core Concept: Unruptured tubal pregnancy is a ectopic pregnancy where the fertilized egg implants in the fallopian tube, leading to potential life-threatening complications if left untreated.

Correct Answer: C. Medical management

**Why the Correct Answer is Right:**
In the case of unruptured tubal pregnancy, the correct management approach aims to prevent potential life-threatening complications such as rupture, hemorrhage, and sepsis. Medical management focuses on controlling the patient's symptoms, reducing the risk of complications, and monitoring the progression of the pregnancy.

**Why Each Wrong Option is Incorrect:**
A. Surgery (Option A): This is not the right answer as medical management is a safer and more conservative approach to treat unruptured tubal pregnancies.
B. Observation (Option B): Observing without intervention increases the risk of complications.
C. Medical management (Option C): This is the correct answer, as it focuses on controlling symptoms, preventing complications, and monitoring the pregnancy while avoiding unnecessary surgical intervention.
D. Radical surgery (Option D): This is incorrect as it is too aggressive, leading to unnecessary complications and potential long-term consequences.

**Why Medical Management is the Right Choice:**
Medical management of unruptured tubal pregnancy involves the administration of methotrexate (MTX), a folic acid antagonist and anti-proliferative agent that can be used to achieve successful pregnancy termination and control symptoms. MTX is administered systemically, and its action includes inhibiting DNA synthesis, leading to the death of rapidly dividing cells, including the trophoblasts in the ectopic pregnancy site. This helps to reduce the risk of complications and allows for regular monitoring of the patient's condition, ensuring that the pregnancy does not rupture or lead to severe hemorrhage.

**Clinical Pearl:**
In cases of unruptured tubal pregnancy, medical management is a safe and effective approach that involves careful monitoring and administration of methotrexate to control symptoms, prevent complications, and observe the progress of the pregnancy. This method ensures patient safety while minimizing the risks associated with surgical intervention.