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Ectopic pregnancy
Scan diagnosis and choosing expectant, methotrexate or surgery.
Source: NICE NG126 (2026) Calculator
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Scan
| Diagnostic | Adnexal mass moving separately from ovary with a sac containing yolk sac or fetal pole. |
|---|---|
| Highly likely | Empty extra-uterine sac (“bagel sign”) or complex inhomogeneous mass. |
Management
| Expectant | Stable, pain-free, mass <35 mm, no heartbeat, hCG ≤1000 IU/L (consider up to 1500). hCG days 2, 4, 7. |
|---|---|
| Methotrexate | No significant pain, unruptured, mass <35 mm, no heartbeat, hCG <1500, no IUP, can return. hCG 1500–4999: methotrexate or surgery. |
| Surgery | Significant pain, mass ≥35 mm, heartbeat seen, hCG ≥5000, or cannot return. |
Methotrexate points
- Usual UK dose 50 mg/m² IM single dose (check local protocol)
- hCG on days 4 and 7, then weekly to negative
- Avoid pregnancy for 3 months; no NSAIDs or folate meanwhile
Shocked or ruptured: resuscitate and go straight to theatre.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.