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Ectopic pregnancy — RACGP Fellowship MCQ

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HardWomen's health and O&GEctopic pregnancyRACGP Fellowship

A haemodynamically stable woman at 6+4 weeks has light bleeding and unilateral pelvic pain. Serum hCG is 1,720 IU/L; expert transvaginal ultrasound shows no intrauterine gestational sac, adnexal mass or free fluid. The pregnancy is desired. What is the most appropriate next step?

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

Reveal the answer and explanation

Correct answer: D — Repeat quantitative hCG and transvaginal ultrasound in 48–72 hours with ectopic safety-netting

Explanation lettering: D = shown as A · E = shown as C · A = shown as D · C = shown as E

A is correct. This is a pregnancy of unknown location, not yet a proven ectopic pregnancy. In a stable patient with non-diagnostic ultrasound, serial quantitative hCG and repeat expert transvaginal ultrasound in 48–72 hours, plus clear emergency return advice, protect a desired potentially viable pregnancy. B risks terminating an intrauterine pregnancy. C is unnecessarily invasive without deterioration. D over-interprets one empty scan. E delays surveillance of a potentially life-threatening ectopic pregnancy.

Reference: RACGP, Early pregnancy bleeding: https://www.racgp.org.au/afp/2016/may/early-pregnancy-bleeding/