A 31-year-old gravida 3 presents at 9 weeks with painless vaginal bleeding. Speculum examination reveals a bulging, barrel-shaped cervix with a patulous os and minimal bleeding from the external os. Ultrasound shows an empty uterine cavity with a gestational sac entirely within an expanded cervical stroma containing fetal cardiac activity. She desires to retain fertility. Best initial management is:

• A Immediate suction curettage through the cervix
• B Systemic methotrexate therapy ✓
• C Emergency total hysterectomy
• D McDonald cerclage to compress the sac

Explanation

This is a cervical ectopic pregnancy. Because the cervix is composed mainly of fibrous tissue with poor contraction, blind curettage can trigger torrential, sometimes life-threatening haemorrhage requiring hysterectomy. In a stable patient wishing fertility, systemic methotrexate is first-line, with adjuncts such as potassium chloride injection or uterine artery embolisation when cardiac activity is present. Cerclage has no role. Hysterectomy is reserved for uncontrolled haemorrhage.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.