A 31-year-old woman who conceived by in vitro fertilisation presents at 7 weeks with right iliac fossa pain. Ultrasound confirms a live intrauterine pregnancy but also shows a 3 cm right adnexal ring with free fluid in the pouch of Douglas. She is haemodynamically stable. Best next step:
- A Diagnostic laparoscopy with salpingostomy or salpingectomy, continuing the intrauterine pregnancy ✓
- B Administer single-dose intramuscular methotrexate
- C Reassure and follow the intrauterine pregnancy only
- D Evacuate the intrauterine pregnancy before treating the adnexal mass
Correct answer: A. Diagnostic laparoscopy with salpingostomy or salpingectomy, continuing the intrauterine pregnancy
Explanation
Heterotopic pregnancy, rare spontaneously (about 1 in 4000) but much more frequent after assisted reproduction (up to 1 in 100), must be treated surgically even with a viable coexisting intrauterine pregnancy. Laparoscopic management of the ectopic with preservation of the intrauterine pregnancy is standard. Methotrexate is absolutely contraindicated because it would harm the wanted intrauterine fetus.
Reference: Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.