Early pregnancy: cervical 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: cervical pregnancy

Sample item

A woman at 8 weeks has painless vaginal bleeding. On examination the cervix is ballooned and barrel-shaped, with the external os partly open and the uterine fundus smaller than the cervix. What is the diagnosis?

ACarcinoma of the cervixBCervical fibroid polypCIncompetent os in the second trimesterDCervical ectopic pregnancy

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

The answer and the reasoning

D. Cervical ectopic pregnancy

In cervical pregnancy the trophoblast implants within the endocervical canal, producing a hourglass uterus, a barrel-shaped enlarged cervix and painless bleeding. Curettage can cause torrential haemorrhage, so methotrexate or conservative procedures with haemostatic measures are preferred. Ultrasound shows a sac below the internal os with an empty uterine cavity.

Option by option

A. Carcinoma of the cervix
Carcinoma does not present with an early pregnancy sac.
B. Cervical fibroid polyp
A fibroid polyp would not be associated with a positive pregnancy and a gestational sac.
C. Incompetent os in the second trimester
Cervical incompetence is a second-trimester painless dilatation, not an 8-week sac.
D. Cervical ectopic pregnancy (correct)
Correct. A barrel-shaped cervix larger than the fundus with painless bleeding is classic.

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.

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Cervical ectopic pregnancy. In cervical pregnancy the trophoblast implants within the endocervical canal, producing a hourglass uterus, a barrel-shaped enlarged cervix and painless bleeding.

Why is "Carcinoma of the cervix" not the answer?

Carcinoma does not present with an early pregnancy sac.

Why is "Cervical fibroid polyp" not the answer?

A fibroid polyp would not be associated with a positive pregnancy and a gestational sac.

Why is "Incompetent os in the second trimester" not the answer?

Cervical incompetence is a second-trimester painless dilatation, not an 8-week sac.

What concept does this question test?

It tests Early pregnancy: cervical pregnancy in OBG. Curettage can cause torrential haemorrhage, so methotrexate or conservative procedures with haemostatic measures are preferred. Ultrasound shows a sac below the internal os with an empty uterine cavity.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: cervical 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.