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Ectopic pregnancy — USMLE Step 3 MCQ

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HardOB/GYN (prenatal care, contraception, screening)Ectopic pregnancyUSMLE Step 3

A 33-year-old at 7 weeks after in vitro fertilization has sudden right pelvic pain, hypotension, and free intraperitoneal fluid. Ultrasound shows a viable intrauterine pregnancy and a separate right tubal mass with cardiac activity. Which management is most appropriate?

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Correct answer: E — Perform urgent operative salpingectomy while preserving the intrauterine pregnancy

The best answer is “Perform urgent operative salpingectomy while preserving the intrauterine pregnancy”. This is a ruptured heterotopic pregnancy after assisted reproduction. Hemoperitoneum and hypotension require urgent operative control of the tubal pregnancy while preserving the viable intrauterine gestation. Local injection or expectant management is reserved for selected stable, unruptured cases, and systemic methotrexate would harm the intrauterine pregnancy.

Reference: ACOG, Tubal Ectopic Pregnancy Practice Bulletin: https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/03/tubal-ectopic-pregnancy