Early pregnancy: caesarean scar pregnancy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Early pregnancy: caesarean scar pregnancy

Sample item

A woman with two previous caesarean sections has 7 weeks of amenorrhoea and light bleeding. Transvaginal scan shows an empty uterine cavity and cervical canal with a gestational sac embedded in the anterior lower uterine segment at the scar. Which step is best avoided?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Blind suction curettage as the first treatment

A sac implanted in the scar niche can bleed catastrophically if curetted blindly, and it may progress to placenta accreta spectrum if continued. Management is individualised, usually methotrexate, guided evacuation or excision, sometimes with embolisation. Blind curettage without control of bleeding is the standard thing to avoid.

Option by option

  • A. Blind suction curettage as the first treatment (correct)

    Correct. Blind curettage risks torrential haemorrhage and uterine rupture and is avoided as primary treatment.

  • B. Ultrasound-guided hysteroscopic or laparoscopic excision

    Guided excision is an accepted definitive approach.

  • C. Local or systemic methotrexate with close follow-up

    Methotrexate is an accepted option in stable patients.

  • D. Uterine artery embolisation followed by evacuation

    Embolisation before evacuation is used to limit bleeding.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Blind suction curettage as the first treatment. A sac implanted in the scar niche can bleed catastrophically if curetted blindly, and it may progress to placenta accreta spectrum if continued.

Why is "Ultrasound-guided hysteroscopic or laparoscopic excision" not the answer?

Guided excision is an accepted definitive approach.

Why is "Local or systemic methotrexate with close follow-up" not the answer?

Methotrexate is an accepted option in stable patients.

Why is "Uterine artery embolisation followed by evacuation" not the answer?

Embolisation before evacuation is used to limit bleeding.

What concept does this question test?

It tests Early pregnancy: caesarean scar pregnancy in OBG. Management is individualised, usually methotrexate, guided evacuation or excision, sometimes with embolisation. Blind curettage without control of bleeding is the standard thing to avoid.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Early pregnancy: caesarean scar pregnancy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.