Ectopic pregnancies account for as many as 18% of patients who present with first-trimester bleeding or abdominal pain in the Emergency Department. This Paucis Verbis card summarizes the 2008 American College of Obstetricians and Gynecologists (ACOG) guidelines on the use of methotrexate (MTX) for ectopic pregnancies. Not all ectopic pregnancies require operative management.
What are the indications and contraindications to MTX? When should they follow up with their obstetrician?
Answer: In 4 days for a repeat b-HCG and possible second dose of MTX
Note that one of the eligibility criteria is that the patient must have an “unruptured ectopic pregnancy”. Many would consider that any ultrasonographic evidence of free fluid may be a sign of an early rupture. It is left up to clinician judgment in how “unruptured” is interpreted.
PV Card: Methotrexate for Ectopic Pregnancy
Adapted from 
Go to ALiEM (PV) Cards for more resources.
- ACOG Practice Bulletin No. 94: Medical Management of Ectopic Pregnancy. Obstetrics & Gynecology. 2008;111(6):1479-1485. doi: 10.1097/aog.0b013e31817d201e