A 24-year-old primigravida presents with a diagnosis of right ectopic pregnancy. Ultrasound reveals a 3 cm right tubal gestational sac with 5-week crown-rump length, negative fetal heart activity, and minimal fluid in the pouch of Douglas. She lives 80 km away from the city center. Vital signs show Blood Pressure 90/50 mmHg, Heart Rate 110/min, Temperature 35.6°C, BMI 36 kg/m², and B-hCG 3500. Which of the following is an absolute contraindication to the use of methotrexate for this patient?
August 30, 2026 98
