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Ectopic pregnancy — MCCQE Part 1 MCQ

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ModeratePelvic PainEctopic pregnancyMCCQE Part 1

A 29-year-old woman presents with unilateral pelvic pain and light vaginal bleeding. Last menstrual period was 7 weeks ago, urine pregnancy test is positive, blood pressure is 96/60 mmHg and transvaginal ultrasound shows no intrauterine pregnancy with free pelvic fluid. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Urgent gynaecology assessment for suspected ruptured ectopic pregnancy

Pregnancy with pelvic pain, bleeding, no intrauterine pregnancy and free fluid is ectopic pregnancy until proven otherwise, especially with haemodynamic concern. Stable pregnancy of unknown location can be followed with serial hCG and ultrasound, but free fluid and low blood pressure require urgent assessment. Cystitis or contraception management would miss a life-threatening diagnosis.

Reference: SOGC ectopic pregnancy guidance; provincial early pregnancy pathways