Ectopic pregnancy – expectant management criteria?

I'd lean toward MTX here — single dose is well-tolerated and avoids the uncertainty of expectant management. Make sure there are no contraindications (renal/liver function, blood count). Counsel about the ectopic rupture risk even post-MTX.

With hCG under 1500 and a small adnexal mass, expectant management is a valid option if the patient is compliant and you have reliable follow-up. Repeat hCG in 48h — if it drops >15%, continue watching. MTX if it plateaus or rises.