Early pregnancy: heterotopic 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.

Try it

OBG · Early pregnancy: heterotopic pregnancy

Sample item

A 29-year-old at 7 weeks after embryo transfer for IVF (two embryos) has lower abdominal pain. Ultrasound shows a live intrauterine gestation and a complex right adnexal mass with free fluid. What is the likely diagnosis and approach?

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

The answer and the reasoning

C. Heterotopic pregnancy; surgical removal of the ectopic while preserving the intrauterine pregnancy

Heterotopic pregnancy, coexisting intrauterine and extrauterine gestations, is rare naturally (about 1 in 30,000) but far more frequent after assisted reproduction. Methotrexate would harm the viable intrauterine fetus, so laparoscopic salpingectomy or other surgical removal is preferred. Seeing an intrauterine sac does not exclude ectopic pregnancy after ART.

Option by option

  • A. Threatened abortion; start progesterone

    Progesterone would not treat an ectopic gestation.

  • B. Corpus luteum cyst; reassure and discharge

    A complex adnexal mass with free fluid is not a simple corpus luteum cyst after IVF.

  • C. Heterotopic pregnancy; surgical removal of the ectopic while preserving the intrauterine pregnancy (correct)

    Correct. An ectopic coexisting with a live intrauterine pregnancy after ART is treated surgically, not with methotrexate.

  • D. Ovarian hyperstimulation; start methotrexate

    Methotrexate is contraindicated when a desired intrauterine pregnancy exists.

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 C, Heterotopic pregnancy; surgical removal of the ectopic while preserving the intrauterine pregnancy. Heterotopic pregnancy, coexisting intrauterine and extrauterine gestations, is rare naturally (about 1 in 30,000) but far more frequent after assisted reproduction.

Why is "Threatened abortion; start progesterone" not the answer?

Progesterone would not treat an ectopic gestation.

Why is "Corpus luteum cyst; reassure and discharge" not the answer?

A complex adnexal mass with free fluid is not a simple corpus luteum cyst after IVF.

Why is "Ovarian hyperstimulation; start methotrexate" not the answer?

Methotrexate is contraindicated when a desired intrauterine pregnancy exists.

What concept does this question test?

It tests Early pregnancy: heterotopic pregnancy in OBG. Methotrexate would harm the viable intrauterine fetus, so laparoscopic salpingectomy or other surgical removal is preferred. Seeing an intrauterine sac does not exclude ectopic pregnancy after ART.

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: heterotopic 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.