Which of the following is the contraindication for the medical management of ectopic pregnancy

Indications and Contraindications for Medical management in Ectopic pregnancy* Absolute Requirements1. Hemodynamic stability2. No evidence of acute intra-abdominal bleeding3. Reliable commitment to comply with required follow-up care4. No contraindications to methotrexate treatment* Preferred Characteristics1. Absent or mild symptoms (pain)2. Serum b-hCG concentration less than 5,000 IU/L 3. Absent embryonic hea activity4. Ectopic mass measuring less than 4 cm in diameter* Contraindications to Methotrexate Treatment1. Breastfeeding2. Immunodeficiency states3. Hematologic abnormalities (severe anaemia, leukopenia, thrombocytopenia)4. Known sensitivity to methotrexate5. Active pulmonary disease6. Active peptic ulcer disease7. Alcoholism8. Clinically impoant hepatic or renal dysfunctionReference: Clinical Gynecologic Endocrinology; 8th edition; Chapter 33; Ectopic Pregnancy