skip to main content

Medical management of ectopic pregnancy — DRCOG MCQ

Instant feedback + full explanation. One question, done properly.

HardEarly PregnancyMedical management of ectopic pregnancyDRCOG

A pain-free, haemodynamically stable woman has a confirmed 24 mm unruptured tubal ectopic pregnancy with no fetal heartbeat and hCG 1,200 IU/L. She can return reliably and strongly wishes to avoid surgery. Which counselling is most accurate?

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

Reveal the answer and explanation

Correct answer: C — Discuss either expectant management or methotrexate with serial hCG follow-up

The best answer is “Discuss either expectant management or methotrexate with serial hCG follow-up”. Her stability, absence of pain, tubal mass below 35 mm without a heartbeat, hCG between 1,000 and 1,500 IU/L and reliable follow-up make both expectant management and methotrexate reasonable options under NICE guidance. Their success rates, adverse effects, need for serial hCG monitoring and possibility of rescue surgery should be discussed. Surgery is not mandatory solely because hCG exceeds 1,000 IU/L. Neither unmonitored observation nor misoprostol safely treats a tubal ectopic pregnancy.

Reference: NICE NG126: Ectopic pregnancy and miscarriage: https://www.nice.org.uk/guidance/ng126/chapter/recommendations