A 28-year-old with 6 weeks of amenorrhoea has mild left iliac fossa pain. Pulse is 84/min and BP 118/76 mm Hg. Transvaginal ultrasound shows an empty uterus and a 2.5 cm unruptured left adnexal mass with no cardiac activity and no free fluid. Serum beta-hCG is 1,800 mIU/mL, and blood counts, liver and kidney tests are normal. She wants to avoid surgery and can attend follow-up. What is the best management?

Single-dose intramuscular methotrexate

Laparoscopic left salpingectomy

Expectant management without drugs

A 20-year-old primigravida at 11 weeks of amenorrhoea presents to a district hospital with vaginal bleeding and severe vomiting. The uterus is 16 weeks in size and doughy, with no fetal heart on Doppler; BP is 146/94 mm Hg with proteinuria 2+. Serum beta-hCG is 280,000 mIU/mL. Ultrasound shows a uterus filled with a multicystic echogenic mass, no fetus, and bilateral multiloculated ovarian cysts. What is the most likely diagnosis?

Missed abortion with degeneration

Twin pregnancy with pre-eclampsia

A 26-year-old with 7 weeks of amenorrhoea collapses at home and is brought to casualty with severe lower abdominal pain and shoulder-tip pain. She is pale and cold; pulse is 128/min, BP 78/50 mm Hg, the abdomen is distended and tender, and urine pregnancy test is positive. Bedside ultrasound shows an empty uterus and free fluid in the abdomen. Two large-bore cannulas are in and blood is being crossmatched. What is the next step?

Immediate laparotomy with ongoing resuscitation

Culdocentesis before deciding on surgery

CT abdomen to confirm the bleeding source

Intramuscular methotrexate and close observation

Early pregnancy: abortion, ectopic and molar pregnancy

33 NEET-PG practice questions on Early pregnancy: abortion, ectopic and molar pregnancy, part of Obstetrics & Gynaecology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 28-year-old with 6 weeks of amenorrhoea has mild left iliac fossa pain. Pulse is 84/min and BP 118/76 mm Hg. Transvaginal ultrasound shows an empty uterus and a 2.5 cm unruptured left adnexal mass with no cardiac activity and no free fluid. Serum beta-hCG is 1,800 mIU/mL, and blood counts, liver and kidney tests are normal. She wants to avoid surgery and can attend follow-up. What is the best management?
1. ASingle-dose intramuscular methotrexate
2. BLaparoscopic left salpingectomy
3. CExpectant management without drugs
4. DDilatation and curettage
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Answer: A · Single-dose intramuscular methotrexate
She is stable with a small unruptured tubal ectopic, no cardiac activity, beta-hCG well below 5,000 mIU/mL and normal blood, liver and kidney tests, so she meets the criteria for medical treatment. Methotrexate, a folic acid antagonist, stops trophoblast division; the single-dose regimen is 50 mg/m2 IM, with beta-hCG checked on days 4 and 7 and a fall of at least 15% expected. She is told to avoid folic acid supplements, NSAIDs and alcohol, and to return at once if pain increases. Surgery is needed if the tube ruptures, the patient is unstable or hCG does not fall.
- B: Surgery is for rupture, instability, high hCG or failed methotrexate.
- C: Expectant care suits low hCG levels that are already falling.
- D: Curettage empties the uterus; the pregnancy here is in the tube.
Question 2 · Medium
A 20-year-old primigravida at 11 weeks of amenorrhoea presents to a district hospital with vaginal bleeding and severe vomiting. The uterus is 16 weeks in size and doughy, with no fetal heart on Doppler; BP is 146/94 mm Hg with proteinuria 2+. Serum beta-hCG is 280,000 mIU/mL. Ultrasound shows a uterus filled with a multicystic echogenic mass, no fetus, and bilateral multiloculated ovarian cysts. What is the most likely diagnosis?
1. APartial hydatidiform mole
2. BMissed abortion with degeneration
3. CTwin pregnancy with pre-eclampsia
4. DComplete hydatidiform mole
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Answer: D · Complete hydatidiform mole
A uterus larger than dates, very high hCG, hyperemesis, pre-eclampsia before 20 weeks and a 'snowstorm' mass with no fetus point to complete hydatidiform mole. The ovarian cysts are theca lutein cysts caused by hCG stimulation; they regress after evacuation and need no surgery unless they twist or rupture. Pre-eclampsia before 20 weeks should always prompt a search for a mole. Partial moles usually have fetal parts, a smaller uterus and lower hCG.
- A: Partial mole usually shows fetal parts and less marked hCG rise.
- B: Missed abortion has a small uterus and low hCG.
- C: A twin pregnancy would show two fetuses on ultrasound.
Question 3 · Easy
A 27-year-old with 7 weeks of amenorrhoea undergoes laparoscopy at a medical college hospital for an unruptured tubal ectopic pregnancy. The surgeon tells the residents that the swelling lies in the commonest site for a tubal pregnancy. Which part of the fallopian tube is this?
1. AIsthmus
2. BAmpulla
3. CInterstitial portion
4. DFimbrial end
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Answer: B · Ampulla
About 70-80% of tubal pregnancies implant in the ampulla, the widest part of the tube where fertilisation normally occurs. The isthmus is next; it is narrow, so rupture comes early, at about 6-8 weeks. Interstitial pregnancies are uncommon, are surrounded by myometrium and rupture late with heavy bleeding. Ampullary pregnancies may also end as tubal abortion through the fimbrial end.
- A: The isthmus is the second commonest site.
- C: Interstitial pregnancy is uncommon, a few percent of cases.
- D: Fimbrial implantation is the least common tubal site.
Question 4 · Easy
A 30-year-old who had a molar pregnancy 4 months ago presents to the medical college casualty with haemoptysis and breathlessness. Serum beta-hCG is 95,000 mIU/mL and curettage of a bleeding uterine lesion showed sheets of cytotrophoblast and syncytiotrophoblast with no chorionic villi. Which organ is the most common site of spread of this tumour?
1. ABrain
2. BLiver
3. CBone
4. DLungs
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Answer: D · Lungs
Sheets of malignant cytotrophoblast and syncytiotrophoblast without villi, with very high hCG after a mole, are choriocarcinoma. It spreads by blood early, most often to the lungs (about 80% of metastatic cases), then the vagina, while liver and brain metastases mark high-risk disease. Vaginal metastases are very vascular and are not biopsied, as they can bleed heavily. Choriocarcinoma is highly sensitive to chemotherapy.
- A: Brain metastasis is less common and scores as high-risk.
- B: Liver metastasis is less common and scores as high-risk.
- C: Bone is a rare site of spread.
Question 5 · Medium
A 26-year-old with 7 weeks of amenorrhoea collapses at home and is brought to casualty with severe lower abdominal pain and shoulder-tip pain. She is pale and cold; pulse is 128/min, BP 78/50 mm Hg, the abdomen is distended and tender, and urine pregnancy test is positive. Bedside ultrasound shows an empty uterus and free fluid in the abdomen. Two large-bore cannulas are in and blood is being crossmatched. What is the next step?
1. ACuldocentesis before deciding on surgery
2. BImmediate laparotomy with ongoing resuscitation
3. CCT abdomen to confirm the bleeding source
4. DIntramuscular methotrexate and close observation
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Answer: B · Immediate laparotomy with ongoing resuscitation
Shock with a positive pregnancy test, an empty uterus and haemoperitoneum is ruptured ectopic pregnancy until proved otherwise. Bleeding will not stop without surgery, so she goes to theatre while resuscitation continues; salpingectomy at laparotomy stops the bleeding. Laparoscopy is used only when the patient is stable enough and the expertise is available. Shoulder-tip pain is referred pain from blood irritating the diaphragm through the phrenic nerve (C3-C5).
- A: Ultrasound has already shown free fluid; culdocentesis adds delay and nothing more.
- C: Imaging delays surgery in an unstable patient.
- D: Methotrexate is contraindicated in rupture or instability.
Question 6 · Medium
A 30-year-old who has had three consecutive miscarriages at 8-10 weeks is seen in the gynae OPD of a medical college. Lupus anticoagulant was positive on two occasions 12 weeks apart; parental karyotypes, thyroid function and uterine cavity are normal. She has never had a thrombosis. She now has a positive urine pregnancy test. Which treatment is recommended?
1. ALow-dose aspirin with prophylactic LMWH
2. BWarfarin from the first trimester
3. CIntravenous immunoglobulin monthly
4. DPrednisolone throughout pregnancy
Answer and explanation in LearnFree account
Question 7 · Medium
A 25-year-old with 6 weeks of amenorrhoea and slight spotting is seen in the gynae OPD. She has no pain, pulse 78/min and BP 116/74 mm Hg. Transvaginal ultrasound shows neither an intrauterine nor an adnexal pregnancy and no free fluid. Serum beta-hCG is 900 mIU/mL; the hospital's discriminatory level for transvaginal scan is 1,500 mIU/mL. What is the most appropriate next step?
1. ASingle-dose intramuscular methotrexate
2. BDilatation and curettage now
3. CRepeat serum beta-hCG in 48 hours
4. DDiagnostic laparoscopy today
Answer and explanation in LearnFree account
Question 8 · Easy
A 25-year-old Rh D-negative woman, whose husband is Rh D-positive, undergoes manual vacuum aspiration at a district hospital for an incomplete abortion at 9 weeks. Her indirect Coombs test is negative. As taught in standard Indian texts, what dose of anti-D immunoglobulin should she receive?
1. A300 µg intramuscularly
2. BNo anti-D is needed
3. C50 µg intramuscularly
4. D1,500 µg intramuscularly
Answer and explanation in LearnFree account
Question 9 · Hard
A 33-year-old conceived by IVF with transfer of two embryos. At 7 weeks she reports right iliac fossa pain. She is stable. Transvaginal ultrasound shows a live intrauterine embryo and also a 2.5 cm right adnexal mass containing a yolk sac, with a little fluid in the pouch of Douglas. She wants to continue the intrauterine pregnancy. What is the best management?
1. ASingle-dose systemic methotrexate
2. BSuction evacuation and then methotrexate
3. CLaparoscopic right salpingectomy
4. DExpectant care with serial hCG
Answer and explanation in LearnFree account
Question 10 · Medium
A 30-year-old third gravida at 9 weeks presents to a CHC with bleeding and passage of fleshy tissue at home. She is still bleeding heavily with clots; pulse is 104/min and BP 104/70 mm Hg, improving with IV fluids. The os is open and tissue is felt in the canal, and ultrasound shows retained products of 32 mm. What is the most appropriate method to empty the uterus?
1. ASharp metal curettage
2. BOral mifepristone alone
3. CAbdominal hysterotomy
4. DManual vacuum aspiration
Answer and explanation in LearnFree account
Question 11 · Medium
A 24-year-old at 12 weeks has an ultrasound diagnosis of complete hydatidiform mole at a medical college hospital. Her haemoglobin, blood group, liver and kidney tests, thyroid function and chest X-ray have been done, and two units of blood are crossmatched. She wants to have children later. What is the treatment of choice?
1. AProphylactic methotrexate, then curettage
2. BSuction evacuation of the uterus
3. CMedical evacuation with misoprostol
4. DTotal hysterectomy with the mole in situ
Answer and explanation in LearnFree account
Question 12 · Medium
Curettings from a 27-year-old with a missed abortion at 10 weeks show some hydropic villi, and the pathologist cannot separate a hydropic abortion from a molar pregnancy on morphology. Immunohistochemistry shows no nuclear p57 staining in the villous cytotrophoblast and stromal cells, while the internal control cells stain. What does this result indicate?
1. APlacental site nodule
2. BComplete hydatidiform mole
3. CPartial hydatidiform mole
4. DHydropic non-molar abortion
Answer and explanation in LearnFree account
Question 13 · Medium
A 34-year-old with a past episode of pelvic inflammatory disease treated at a PHC now has a tubal ectopic pregnancy. Her NAAT at that time was positive for Chlamydia trachomatis. How does this past infection lead to ectopic pregnancy?
1. AAntibodies against trophoblast attack the endometrium
2. BDamaged cilia and intraluminal adhesions delay ovum transport
3. CRaised progesterone stops tubal smooth muscle activity
4. DBacteria persisting in the tube attract the blastocyst
Answer and explanation in LearnFree account
Question 14 · Medium
A 19-year-old at 13 weeks with a complete hydatidiform mole has tremor, palpitations, heat intolerance and a pulse of 120/min. Serum beta-hCG is 410,000 mIU/mL, free T4 is high and TSH is suppressed; there is no goitre or eye sign. What is the mechanism of her thyroid overactivity?
1. AMolar tissue secretes T4 directly
2. BAntibodies stimulate the TSH receptor
3. ChCG stimulates the TSH receptor
4. DIodine excess from the molar tissue
Answer and explanation in LearnFree account
Question 15 · Medium
A 25-year-old is reviewed in the gynae OPD a week after suction evacuation of a complete mole. The doctor discusses four points with her: 1. Serum hCG will be measured serially until it is normal and then for a period afterwards. 2. She should avoid pregnancy until the follow-up period is over. 3. An intrauterine device is avoided until hCG is normal. 4. Every woman with a complete mole receives prophylactic methotrexate. Which points are correct advice?
1. A1, 3 and 4 only
2. B1 and 3 only
3. C2 and 4 only
4. D1, 2 and 3 only
Answer and explanation in LearnFree account
Question 16 · Medium
A 29-year-old at 12 weeks is brought to casualty in shock after sudden severe abdominal pain. A scan at 8 weeks in another clinic had reported a gestational sac high in the right side of the uterine fundus, eccentrically placed, with a thin layer of myometrium around it. At laparotomy there is massive haemoperitoneum and a bulging rupture lateral to the round ligament at the right uterine angle. What type of ectopic pregnancy is this?
1. AInterstitial
2. BAmpullary
3. CCervical
4. DIsthmic
Answer and explanation in LearnFree account
Question 17 · Medium
A 30-year-old with 7 weeks of amenorrhoea and spotting undergoes uterine curettage in a small hospital before a scan is done. Histopathology reports endometrium with enlarged, hyperchromatic, pleomorphic nuclei and clear vacuolated cytoplasm bulging into the gland lumen, with decidual change and no chorionic villi. The surgeon is worried about cancer. What is the correct interpretation of these atypical cells?
1. AComplex atypical endometrial hyperplasia
2. BBenign hormonal change of pregnancy
3. CPlacental site trophoblastic tumour
4. DEndometrial clear cell carcinoma
Answer and explanation in LearnFree account
Question 18 · Medium
A 34-year-old has irregular vaginal bleeding 14 months after a normal term delivery. The uterus is slightly bulky, serum beta-hCG is only 160 mIU/mL, and serum human placental lactogen is raised. Hysteroscopic biopsy shows a tumour of intermediate trophoblast infiltrating the myometrium, with no villi, and there is no spread on staging. What is the treatment of choice?
1. ASingle-agent methotrexate
2. BTotal hysterectomy
3. CSingle-agent actinomycin D
4. DSuction evacuation and hCG follow-up
Answer and explanation in LearnFree account
Question 19 · Hard
A 28-year-old is diagnosed with post-molar gestational trophoblastic neoplasia 2 months after evacuation of a complete mole. Pre-treatment hCG is 8,000 mIU/mL, the uterus contains a 2 cm lesion, and chest X-ray shows two lung nodules; liver and brain imaging are normal and she has had no chemotherapy. Her FIGO/WHO prognostic score is 2 (low risk). What is the treatment of choice?
1. ATotal hysterectomy with lung resection
2. BWhole-brain and lung radiotherapy
3. CSingle-agent methotrexate chemotherapy
4. DEMA-CO multi-agent chemotherapy
Answer and explanation in LearnFree account
Question 20 · Easy
A 22-year-old has suction evacuation for a molar pregnancy at a district hospital. Histology shows diffuse hydropic villi with circumferential trophoblast proliferation and no fetal tissue; cytogenetics shows a diploid karyotype. Which karyotype is most typical of this lesion?
1. A47,XX,+16
2. B69,XXY triploid
3. C46,XX with one maternal set
4. D46,XX of paternal origin
Answer and explanation in LearnFree account
Question 21 · Medium
A 22-year-old is brought to the casualty of a medical college hospital 3 days after a pregnancy of 10 weeks was ended by an untrained person in her village. She has fever of 39.4 °C, pulse 118/min, BP 100/66 mm Hg, foul-smelling discharge and lower abdominal tenderness; the os is open and ultrasound shows retained products. Blood is sent for cultures. What is the most appropriate next step?
1. AOral antibiotics and review after a week
2. BEvacuation only after 5 days of antibiotics
3. CIV broad-spectrum antibiotics, then evacuation
4. DImmediate total abdominal hysterectomy
Answer and explanation in LearnFree account
Question 22 · Medium
A 32-year-old has a laparoscopy at a district hospital for a 3 cm unruptured tubal ectopic pregnancy in the right ampulla, with mild haemoperitoneum. The left tube and ovary look entirely normal. She hopes to have more children. Which procedure is preferred on the right tube?
1. ALaparoscopic salpingostomy
2. BRemoval of the right tube and ovary
3. CLaparoscopic salpingectomy
4. DMilking the pregnancy out of the fimbria
Answer and explanation in LearnFree account
Question 23 · Hard
A 23-year-old had suction evacuation of a complete mole 7 weeks ago. She uses condoms and has no bleeding. Weekly serum beta-hCG values (mIU/mL) at a medical college are: 1,860; 1,820; 1,880; 1,840. Ultrasound shows an empty uterus with no retained tissue. What does this pattern indicate?
1. APost-molar gestational trophoblastic neoplasia
2. BPhantom hCG from heterophile antibodies
3. CNormal regression after molar evacuation
4. DA new intrauterine pregnancy
Answer and explanation in LearnFree account
Question 24 · Medium
A 23-year-old primigravida at 8 weeks with mild spotting and a live intrauterine pregnancy asks the doctor in the ANC clinic, in tears, whether she must stay in bed for the rest of the trimester and whether lifting her toddler caused the bleeding. What is the most appropriate advice?
1. AAdmit for bed rest and daily injections of hCG
2. BAvoid all lifting and work until 20 weeks of pregnancy
3. CStrict bed rest until the bleeding stops completely
4. DBed rest is not proven to help, and she did not cause it
Answer and explanation in LearnFree account
Question 25 · Medium
A 28-year-old with 7 weeks of amenorrhoea and a confirmed intrauterine pregnancy requests medical termination at a PHC approved for MTP. The medical officer reviews four points before giving mifepristone and misoprostol: 1. She has a copper IUD still in place. 2. She takes long-term oral prednisolone for nephrotic syndrome. 3. She had one lower segment caesarean 3 years ago. 4. She has a family diagnosis of acute intermittent porphyria and has had attacks. Which points are contraindications to medical abortion at this visit?
1. A2, 3 and 4 only
2. B1, 2, 3 and 4
3. C1 and 4 only
4. D1, 2 and 4 only
Answer and explanation in LearnFree account

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Early pregnancy: abortion, ectopic and molar pregnancy

A 27-year-old with 7 weeks of amenorrhoea undergoes laparoscopy at a medical college hospital for an unruptured tubal ectopic pregnancy. The surgeon tells the residents that the swelling lies in the commonest site for a tubal pregnancy. Which part of the fallopian tube is this?

A 25-year-old Rh D-negative woman, whose husband is Rh D-positive, undergoes manual vacuum aspiration at a district hospital for an incomplete abortion at 9 weeks. Her indirect Coombs test is negative. As taught in standard Indian texts, what dose of anti-D immunoglobulin should she receive?

A 34-year-old with a past episode of pelvic inflammatory disease treated at a PHC now has a tubal ectopic pregnancy. Her NAAT at that time was positive for Chlamydia trachomatis. How does this past infection lead to ectopic pregnancy?

A 19-year-old at 13 weeks with a complete hydatidiform mole has tremor, palpitations, heat intolerance and a pulse of 120/min. Serum beta-hCG is 410,000 mIU/mL, free T4 is high and TSH is suppressed; there is no goitre or eye sign. What is the mechanism of her thyroid overactivity?

A 22-year-old has suction evacuation for a molar pregnancy at a district hospital. Histology shows diffuse hydropic villi with circumferential trophoblast proliferation and no fetal tissue; cytogenetics shows a diploid karyotype. Which karyotype is most typical of this lesion?

A 32-year-old has a laparoscopy at a district hospital for a 3 cm unruptured tubal ectopic pregnancy in the right ampulla, with mild haemoperitoneum. The left tube and ovary look entirely normal. She hopes to have more children. Which procedure is preferred on the right tube?

A 23-year-old had suction evacuation of a complete mole 7 weeks ago. She uses condoms and has no bleeding. Weekly serum beta-hCG values (mIU/mL) at a medical college are: 1,860; 1,820; 1,880; 1,840. Ultrasound shows an empty uterus with no retained tissue. What does this pattern indicate?

A 23-year-old primigravida at 8 weeks with mild spotting and a live intrauterine pregnancy asks the doctor in the ANC clinic, in tears, whether she must stay in bed for the rest of the trimester and whether lifting her toddler caused the bleeding. What is the most appropriate advice?