Expectant management

  • β-hCG level < 1,000 mIU per mL and decreasing

  • Ectopic or adnexal mass < 3 cm or not detected

  • Minimal pain or bleeding

  • No embryonic cardiac activity

  • No evidence of tubal rupture

  • Patient reliable for follow-up and has no barriers to accessing health care

Medical management with methotrexate

  • Absence of embryonic cardiac activity

  • β-hCG level < 2,000 mIU per mL

  • Ectopic mass ≤ 3.5 cm

  • No medical contraindication (hematologic dysfunction; liver, kidney, or pulmonary disease; immunodeficiency; peptic ulcer disease; breastfeeding; sensitivity to methotrexate; alcohol abuse)

  • Patient reliable for follow-up and has no barriers to accessing health care

  • Stable vital signs and few symptoms

  • Unruptured ectopic pregnancy

Surgical management

  • Advanced ectopic pregnancy (high β-hCG level, large mass, embryonic cardiac activity)

  • Contraindications to observation or methotrexate

  • Patient unreliable for follow-up or has barriers to accessing health care (individualization of intervention)

  • Uncertain diagnosis

  • Unstable vital signs or signs of hemoperitoneum