Contraception and Family Planning — MCQs

A 26-year-old woman with 6 weeks of amenorrhea presents to the emergency department with right iliac fossa pain and mild vaginal spotting. Her serum beta-hCG is 2400 mIU/mL. A transvaginal ultrasound is performed and is shown in Image 2, demonstrating an adnexal ring sign with an empty uterine cavity and no fetal cardiac activity on the right side. Her vital signs are: BP 112/74 mmHg, HR 88 bpm, she is hemodynamically stable. She has no contraindications to methotrexate (normal renal, hepatic, and hematologic function; no active pulmonary disease; no breastfeeding) and confirms she is able to comply with close outpatient follow-up. Which of the following is the most appropriate next step in management?