Early pregnancy: pregnancy of unknown location: 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: pregnancy of unknown location

Sample item

A woman with a positive urine test and mild abdominal pain has a serum hCG of 900 IU/L. Transvaginal ultrasound shows no intrauterine or adnexal pregnancy, and she is stable. What is the best next step?

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

The answer and the reasoning

C. Repeat serum hCG after 48 hours and review

This is a pregnancy of unknown location with a level below the discriminatory zone, so an intrauterine pregnancy cannot yet be seen. Repeating hCG after 48 hours identifies the pattern: an adequate rise suggests a viable intrauterine pregnancy, a slow rise or plateau an ectopic, and a fall a failing pregnancy. Treatment before the diagnosis risks harming a normal pregnancy.

Option by option

  • A. Dilatation and curettage

    Curettage might terminate a viable pregnancy.

  • B. Immediate methotrexate

    Methotrexate should not be given without a confirmed diagnosis.

  • C. Repeat serum hCG after 48 hours and review (correct)

    Correct. Serial hCG in a stable woman clarifies the diagnosis safely.

  • D. Immediate laparoscopy

    Surgery is not needed in a stable patient with no confirmed ectopic.

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.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is C, Repeat serum hCG after 48 hours and review. This is a pregnancy of unknown location with a level below the discriminatory zone, so an intrauterine pregnancy cannot yet be seen.

Why is "Dilatation and curettage" not the answer?

Curettage might terminate a viable pregnancy.

Why is "Immediate methotrexate" not the answer?

Methotrexate should not be given without a confirmed diagnosis.

Why is "Immediate laparoscopy" not the answer?

Surgery is not needed in a stable patient with no confirmed ectopic.

What concept does this question test?

It tests Early pregnancy: pregnancy of unknown location in OBG. Repeating hCG after 48 hours identifies the pattern: an adequate rise suggests a viable intrauterine pregnancy, a slow rise or plateau an ectopic, and a fall a failing pregnancy. Treatment before the diagnosis risks harming a normal pregnancy.

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: pregnancy of unknown location?

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.