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