A woman who conceived after IVF embryo transfer presents at 7 weeks with mild abdominal pain. Ultrasound shows a viable intrauterine singleton gestation plus a separate 2 cm right adnexal ring adjacent to the ovary. Serum beta-hCG is 32,000 mIU/mL. What is the most appropriate management?

• A Methotrexate 50 mg/m2 intramuscularly
• B Serial beta-hCG monitoring alone
• C Termination of the entire pregnancy
• D Laparoscopic salpingectomy of the adnexal gestation ✓

Explanation

This is a heterotopic pregnancy, occurring in up to 1 percent of assisted reproduction conceptions compared with about 1 in 30,000 spontaneous pregnancies. The intrauterine fetus can be preserved, so surgical removal of the ectopic by salpingectomy is standard. Methotrexate is contraindicated because it is toxic to the viable intrauterine pregnancy. Serial monitoring alone is unsafe since tubal rupture may occur while the uterus continues to be monitored.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.