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Hypertension in pregnancy — UKMLA MCQ

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HardObstetrics & GynaecologyHypertension in pregnancyUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

A woman with a positive pregnancy test has sudden pelvic pain, syncope, shoulder-tip pain, blood pressure 78/46 mmHg and free intraperitoneal fluid on bedside ultrasound. No intrauterine pregnancy is seen. What is the next step?

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Correct answer: E — Proceed to immediate operative management for presumed ruptured ectopic pregnancy

The best answer is “Proceed to immediate operative management for presumed ruptured ectopic pregnancy”. Haemodynamic collapse, peritoneal blood and a pregnancy of unknown location should be treated as ruptured ectopic pregnancy until proved otherwise. Resuscitation, blood products and immediate gynaecological operative source control are required in parallel. Serial hCG and methotrexate are options only for stable selected patients. Waiting for complete haemodynamic normalisation delays haemorrhage control, and transient analgesic improvement is irrelevant. Absence of a visible adnexal mass does not safely exclude rupture in this physiological context.

Reference: NICE NG126 ectopic pregnancy guideline: https://www.nice.org.uk/guidance/ng126/chapter/recommendations