A 29-year-old woman presents at 8 weeks of gestation with painless heavy vaginal bleeding. On examination the cervix is enlarged, globular and barrel shaped, and bleeds on touch. Transvaginal ultrasound shows an empty upper uterine cavity with a gestational sac implanted below the level of the internal os, surrounded by a thin myometrial mantle. The 'sliding sign' is absent. What is the most appropriate initial management?

• A Immediate suction curettage under ultrasound guidance
• B Systemic methotrexate therapy ✓
• C Emergency hysterectomy
• D Expectant management with weekly beta-hCG

Explanation

The findings define a cervical ectopic pregnancy: sac below the internal os, thin surrounding mantle, barrel cervix and absent sliding sign. Primary medical management with systemic methotrexate is preferred in a stable patient to avoid catastrophic haemorrhage. Blind suction curettage alone risks torrential bleeding because the cervix lacks contractile muscle to close vessels. Hysterectomy is reserved for life-threatening haemorrhage uncontrolled by conservative measures, and expectant management is unsafe for a viable cervical implantation.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.