A woman complains of right-sided lower abdominal pain and mild bleeding per vagina after a POA of 6 weeks. Her general condition is satisfactory. The urine hCG test is positive. Transvaginal ultrasound scan reveals an adnexal mass 30 mm in diameter without evidence of cardiac activity, but no intrauterine pregnancy.What is the most appropriate management?

**Core Concept**
An ectopic pregnancy is a life-threatening condition where a fertilized ovum implants outside the uterus, typically in the fallopian tube. The presence of an adnexal mass without cardiac activity and a positive hCG test confirms this diagnosis. The patient's symptoms and ultrasound findings warrant immediate intervention.

**Why the Correct Answer is Right**
The management of an ectopic pregnancy depends on the patient's hemodynamic stability, the size and location of the ectopic mass, and the presence of any complications such as hemoperitoneum. In this case, the patient is hemodynamically stable, and the ectopic mass is small (30 mm) without evidence of significant bleeding. Medical management with methotrexate is an appropriate option for patients with a stable ectopic pregnancy, as it can prevent further growth and potential rupture. Methotrexate works by inhibiting dihydrofolate reductase (DHFR) in rapidly dividing cells, such as those in the ectopic pregnancy.

**Why Each Wrong Option is Incorrect**
**Option A:** Surgical intervention is typically reserved for patients with hemodynamic instability, a large ectopic mass, or evidence of significant bleeding. It is not the first-line management for a stable patient with a small ectopic mass.

**Option B:** Expectant management is not suitable for this patient, as it involves waiting for spontaneous resolution, which is unlikely with a visible ectopic mass. This approach can lead to significant complications, including rupture and hemoperitoneum.

**Option C:** Laparoscopic surgery may be an option for patients with a stable ectopic pregnancy, but it is not the most appropriate management for a patient with a small ectopic mass who is hemodynamically stable. Medical management with methotrexate is a more conservative approach.

**Option D:** This option is not relevant to the management of an ectopic pregnancy.

**Clinical Pearl / High-Yield Fact**
In cases of suspected ectopic pregnancy, a urine hCG test is a quick and effective initial screening tool. However, it is essential to note that a negative hCG test does not rule out an ectopic pregnancy, especially in patients with a history of previous ectopic pregnancies or those with a high clinical suspicion.

**Correct Answer:** B. Expectant management.

✓ Correct Answer: D. treatment with intramuscular methotrexate