A 29-year-old woman who conceived through IVF with transfer of two embryos presents at 7 weeks with mild right iliac fossa pain. Transvaginal ultrasound shows a live intrauterine gestation and a separate 2.5 cm right adnexal ring with a yolk sac. She is haemodynamically stable. What is the most appropriate initial management?

• A Systemic single-dose methotrexate
• B Expectant management with weekly ultrasound
• C Termination of the intrauterine pregnancy
• D Laparoscopic salpingostomy or salpingectomy ✓

Explanation

This is a heterotopic pregnancy, whose incidence after assisted reproduction approaches 1 in 100 pregnancies, far above the spontaneous rate of about 1 in 4000. Methotrexate is contraindicated because it would also injure the desired viable intrauterine fetus. Expectant management risks catastrophic tubal rupture. Surgical removal of the ectopic gestation, preferably laparoscopic, preserves the ongoing intrauterine pregnancy and is the accepted approach.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.