A 28-year-old woman with 8 weeks amenorrhoea and heavy vaginal bleeding has ultrasound showing an empty uterine cavity with a gestational sac embedded within a ballooned, barrel-shaped cervix below the internal os, with Doppler flow around it. Beta-hCG is 32,000 mIU/mL. She is stable. Preferred initial management:

• A Immediate suction dilatation and curettage of the cervix
• B Total hysterectomy in all cases
• C Systemic methotrexate, with uterine artery embolisation if bleeding develops ✓
• D Expectant management with weekly beta-hCG alone

Explanation

This is a cervical ectopic pregnancy. The cervix is richly supplied by descending cervical branches of the uterine arteries, so blind curettage can trigger torrential, sometimes life-threatening haemorrhage. Stable patients are managed conservatively with systemic methotrexate, with uterine artery embolisation reserved for bleeding or as adjunct before any evacuation. Hysterectomy is reserved for uncontrollable haemorrhage, and expectant management alone is unsafe at this beta-hCG level.

Reference: Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.