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Possible ectopic pregnancy presenting with deep groin pain — MSRA MCQ

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HardHip and GroinPossible ectopic pregnancy presenting with deep groin painMSRA

A 29-year-old woman presents to general practice with 18 hours of constant left-sided deep groin pain and light vaginal spotting. Her last menstrual period was 8 weeks ago; her cycles are normally regular. She has no previous ectopic pregnancy, pelvic inflammatory disease or tubal surgery. She is alert and comfortable while seated. Temperature is 36.7°C, pulse 82 beats/minute and blood pressure 118/72 mmHg. Passive movement of both hips is full and painless. There is mild left iliac fossa tenderness without guarding or rebound. Urine dipstick is negative for blood and nitrites. A urine pregnancy test is positive. What is the most appropriate next step in general practice?

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Correct answer: C — Refer immediately to an early pregnancy assessment service for specialist assessment

This is possible ectopic pregnancy until proven otherwise. The key linked findings are amenorrhoea, vaginal spotting, a positive pregnancy test, unilateral lower abdominal/deep groin pain and abdominal tenderness. Lack of recognised ectopic risk factors does not reduce the need for assessment: NICE advises that ectopic pregnancy must be considered even without risk factors. Full painless passive hip movement and non-mechanical pain make primary intra-articular hip pathology less likely. NICE recommends immediate referral to an early pregnancy assessment service (or out-of-hours gynaecology service where unavailable) for a woman with a positive pregnancy test plus pain and abdominal tenderness. This is therefore the correct primary-care disposition. Direct emergency department transfer is reserved for haemodynamic instability or significant concern about the severity of pain or bleeding; neither is present here. Ultrasound and serum hCG testing are appropriate investigations, but NICE specifies that these are provided through the early pregnancy assessment service and should not delay referral. Serial hCG measurement after 48 hours may be used within specialist management of a pregnancy of unknown location, but is not an appropriate initial community plan in a symptomatic woman with tenderness. Treating a presumed musculoskeletal cause fails to account for the pregnancy-related red flags.

Reference: NICE NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management — Symptoms and signs of ectopic pregnancy and initial assessment (Last updated 17 June 2026) — https://www.nice.org.uk/guidance/NG126/chapter/symptoms-and-signs-of-ectopic-pregnancy-and-initial-assessment NICE NG126: Ectopic pregnancy and miscarriage: diagnosis and initial management — Early pregnancy assessment services (Last updated 17 June 2026) — https://www.nice.org.uk/guidance/NG126/chapter/early-pregnancy-assessment-services