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Ruptured ectopic pregnancy — MCCQE Part 1 MCQ

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HardPregnancyRuptured ectopic pregnancyMCCQE Part 1

33-year-old woman presents with syncope and pelvic pain. She is hypotensive, pregnancy test is positive and has shoulder-tip pain. 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 — Resuscitate and arrange immediate gynaecologic surgery

Resuscitate and arrange immediate gynaecologic surgery is best because shock with positive pregnancy test and abdominal/pelvic pain suggests ruptured ectopic pregnancy. 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. Do not wait for serial beta-hCG in an unstable patient.

Reference: SOGC Guideline No. 414