Optimal Treatment for Women With a Persisting Pregnancy of Unknown Location

Inclusion Criteria:

- Female with a persisting pregnancy of unknown location:

- A pregnancy of unknown location is defined as a pregnancy in a woman with a positive
pregnancy test but no definitive signs of pregnancy in the uterus or adnexa on
ultrasound imaging. A definitive sign of gestation includes ultrasound visualization
of a gestational sac with a yolk sac (with or without an embryo) in the uterus or in
the adnexa. Ultrasound must be performed within 7 days prior to randomization.

- Persistence of hCG is defined as at least 2 serial hCG values (over 2-14 days),
showing < 15% rise per day, or < 50% fall between the first and last value.

- Patient is hemodynamically stable, hemoglobin >10 mg/dL

- Greater than or 18 years of age

Exclusion Criteria:

- Hemodynamically unstable in need of acute treatment

- Most recent hCG > 5000 mIU/mL

- Patient obtaining care in relation to a recently completed pregnancy (delivery,
spontaneous or elective abortion)

- Diagnosis of gestational trophoblastic disease

- Subject unwilling or unable to comply with study procedures

- Known hypersensitivity to MTX

- Presence of clinical contraindications for treatment with MTX

- Prior medical or surgical management of this gestation

- Subject unwilling to accept a blood transfusion