A female patient getting clomiphene citrate therapy, during pregnancy the risk of which complication may increase
A. Ectopic pregnancy
B. Multiple pregnancy
C. Polyhydramnios
D. Missed abortion
Correct Answer: Multiple pregnancy (particularly twins)
A female patient receiving Clomiphene citrate therapy has an increased risk of multiple pregnancy, especially dizygotic twins.
Explanation
Clomiphene citrate is an ovulation-inducing drug used in infertility treatment. It stimulates the release of FSH and LH from the pituitary gland, causing the development and ovulation of more than one ovarian follicle. As a result, more than one ovum may be released and fertilized.
Possible complications during pregnancy associated with Clomiphene
Complication Reason
Multiple pregnancy (Twins) More than one follicle develops and ovulates
Ovarian hyperstimulation syndrome (OHSS) Excessive ovarian enlargement
Increased risk of ectopic pregnancy Due to altered tubal motility
Higher risk of preterm birth & low birth weight (in multiple gestation) Because twins or triplets increase obstetric risk
Most common complication
👉 Multiple pregnancy
Final answer: Risk of multiple pregnancy increases during pregnancy with Clomiphene therapy.
Other Options Deatails
Here is the detailed description of each option:
A. Ectopic Pregnancy
• An ectopic pregnancy occurs when the fertilized ovum implants outside the uterine cavity.
• The most common site is the fallopian tube (ampulla region).
• Other rare sites: ovary, cervix, abdomen.
It is a medical emergency because the growing embryo can rupture the tube, causing severe internal bleeding and shock.
• Symptoms include sharp abdominal pain, vaginal spotting, shoulder tip pain, dizziness, and fainting.
• Treatment: Methotrexate (in early cases) or surgical removal (laparoscopy).
B. Multiple Pregnancy
• Multiple pregnancy means carrying more than one fetus in the uterus at the same time.
• Includes twins, triplets, quadruplets, etc.
• Can be monozygotic (identical) or dizygotic (fraternal).
• Risk factors: fertility drugs (like clomiphene), IVF, older maternal age, family history of twins.
• Complications: preterm birth, anemia, hypertension, increased need for C-section, postpartum hemorrhage.
C. Polyhydramnios
• Polyhydramnios refers to an excessive amount of amniotic fluid around the fetus.
• Measured by an AFI (Amniotic Fluid Index) > 24 cm.
• Common causes include maternal diabetes, fetal anomalies (e.g., anencephaly, esophageal atresia), multiple pregnancy, and Rh incompatibility.
• Symptoms: abdominal discomfort, breathlessness, edema, preterm labor risk.
• Management includes treating underlying causes and performing amnioreduction if severe.
D. Missed Abortion
• Missed abortion (silent miscarriage) occurs when the embryo or fetus dies but is not expelled from the uterus.
• No symptoms of miscarriage (no bleeding or pain initially).
• The uterus stops increasing in size, and pregnancy symptoms disappear (like nausea).
• It is usually diagnosed on ultrasound showing absent heartbeat.
• Treatment: medical (misoprostol), surgical evacuation (D&C), or expectant management.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group)