A 31-year-old G3P2 presents at 8 weeks with painless heavy vaginal bleeding. Transvaginal ultrasound shows an hourglass-shaped uterus, a gestational sac with cardiac activity implanted in the cervix below the internal os, and an empty uterine cavity. Doppler shows marked peritrophoblastic flow. She is haemodynamically stable and desires fertility preservation. Best management?
- A Immediate total hysterectomy
- B Immediate dilation and curettage with sharp curettage of the cervix
- C Systemic methotrexate with planned delayed evacuation once cardiac activity ceases ✓
- D Insertion of an abdominal cerclage to control bleeding
Correct answer: C. Systemic methotrexate with planned delayed evacuation once cardiac activity ceases
Explanation
Cervical ectopic pregnancy is managed medically when the patient is stable: systemic methotrexate, with potassium chloride injection into the sac when cardiac activity is present, followed by evacuation once vascularity regresses. Immediate curettage alone risks catastrophic haemorrhage from trophoblast invading the fibrous cervical stroma, which cannot contract to arrest bleeding. Hysterectomy is reserved for life-threatening haemorrhage in women who have completed childbearing.
Reference: Berek and Novak's Gynecology, 16th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.