Which condition is a relative contraindication for the use of Methotrexate in an ectopic pregnancy?

The use of Methotrexate in the treatment of ectopic pregnancy is primarily aimed at inhibiting cellular proliferation, thus stopping the growth of the ectopic tissue. In considering contraindications for Methotrexate, it is important to understand the implications of elevated hCG levels.

While an initial hCG level greater than 5000 mIU/mL is not an absolute contraindication, it does represent a relative contraindication because higher hCG levels are often associated with more advanced ectopic pregnancy or higher amounts of trophoblastic tissue, which can decrease the likelihood of successful treatment with Methotrexate. In such cases, a different management approach might be necessary, including surgical options.

Active pulmonary disease is another important consideration with Methotrexate, as it is known to have potential toxicity that can exacerbate pre-existing lung conditions. However, this does not make it as directly contraindicated in the context of ectopic pregnancies. Conditions such as severe anemia and leukopenia may affect a patient's overall ability to tolerate medical management but do not pose the same relative risk in the same manner as elevated hCG levels.

Thus, when weighing the risks and benefits of Methotrexate treatment for ectopic pregnancy, an initial hCG level