A 29-year-old woman, gravida 3 para 2, has 9 weeks amenorrhoea. Ultrasound shows an empty gestational sac implanted in the cervix below the internal os with circumferential Doppler flow. During preparation for intervention she develops brisk vaginal bleeding. The best immediate step is:

• A Immediate suction curettage under general anaesthesia
• B High-dose oxytocin infusion with vaginal packing
• C Emergency total hysterectomy as first-line therapy
• D Uterine artery embolisation to secure haemostasis, followed by evacuation or methotrexate ✓

Explanation

This is a cervical ectopic pregnancy. The cervix contains predominantly fibrous tissue with sparse smooth muscle, so after evacuation it cannot contract and compress the vessels, causing torrential haemorrhage. Haemostasis must be secured first, classically with uterine artery embolisation, before evacuation or systemic methotrexate is given. Hysterectomy is reserved for uncontrollable bleeding in women who have completed childbearing, and oxytocin is ineffective on cervical tissue.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.