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Ectopic pregnancy — MCCQE Part 1 MCQ

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EasyPregnancyEctopic pregnancyMCCQE Part 1

29-year-old woman at 7 weeks by dates presents with unilateral pelvic pain and vaginal spotting. She is haemodynamically stable, beta-hCG is positive and transvaginal ultrasound shows no intrauterine pregnancy. Which of the following is the most appropriate next step?

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Correct answer: B — Manage as pregnancy of unknown location with serial beta-hCG and repeat ultrasound/urgent gynae review

Manage as pregnancy of unknown location with serial beta-hCG and repeat ultrasound/urgent gynae review is best because positive pregnancy test with pain and no intrauterine pregnancy requires ectopic pathway. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Ectopic pregnancy remains possible until location is confirmed.

Reference: SOGC Guideline No. 414