A 31-year-old woman who conceived through IVF presents at 7 weeks with mild right pelvic pain. Transvaginal scan shows an intrauterine gestational sac containing a yolk sac, plus a separate 3 cm right adnexal ring with an echogenic centre. She is haemodynamically stable and beta-hCG is 28,000 IU/L. The most appropriate management is:
- A Laparoscopic removal of the adnexal gestation while continuing the intrauterine pregnancy ✓
- B Systemic single-dose methotrexate
- C Suction evacuation of the intrauterine pregnancy followed by methotrexate
- D Expectant management with weekly beta-hCG and serial scans
Correct answer: A. Laparoscopic removal of the adnexal gestation while continuing the intrauterine pregnancy
Explanation
This is a heterotopic pregnancy, whose incidence rises to about 1 in 100 after assisted reproduction. Methotrexate is a folate antagonist and is contraindicated with a viable coexisting intrauterine pregnancy, which eliminates options B and C. Because the intrauterine pregnancy is desired and viable, the ectopic gestation is removed surgically, conserving the uterus and the ongoing pregnancy. Expectant care risks rupture of the adnexal gestation.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.