The midwife in the early pregnancy assessment unit asks you to review a woman who has
seven weeks of amenorrhea but the previous and current ultrasound could not locate the
pregnancy. The human chorionic gonadotropin (BhCG) increased from 800 IU/L to 1600 IU/L
after 48 hours. The woman is fit and well with no signs or symptoms. What is your next plan?

A 25-yr old woman in her second pregnancy at 10 weeks of amenorrhoea attends Casualty
via ambulance after collapsing at home with abdominal pain. She is pale, clammy, has a
distended abdomen and generalized abdominal guarding. Her urine pregnancy test is +ve. She
is a Jehovah’s Witness.

A nulliparous woman presents with lower abdominal pain in early pregnancy. The human
chorionic gonadotrophin (hCG) level is 986 IU/L. At laparoscopy the following is found:

There is no other abnormality seen in the pelvis
What is the most appropriate management option?

. A 32-yr old multiparous woman attends for an early reassure scan. The uterus is empty and
there is no sigh of an extra-uterine pregnancy. The serum HCG was initially 4500 and 48 hours
later was 5000. She has had two previous CS.

A woman who has had a left salpingectomy previously for ectopic pregnancy has now been
diagnosed with an ectopic pregnancy in the right fallopian tube. A laparoscopy is performed and
the surgeon opts for a salpingotomy as the woman still wishes to become pregnant. What is the
possibility that she will require further treatment (methotrexate or salpingectomy)?

The general practitioner calls you out of hours to ask what to do because she has an eightweek pregnant woman who is complaining of moderate right abdominal pain and slight vaginal
bleeding. What is your advice?

A 32-yr old multiparous woman attends for an early reassurance scan. The uterus is empty
and the HCG is 950. She has had 3 laparotomies for Crohn’s disease.

A woman who is Rhesus-negative undergoes a laparoscopic salpingectomy for an ectopic
pregnancy at eight weeks gestation. What dose of anti-D immunoglobulin should she receive
immediately after the operation?

A 26-year nulliparous woman attends the early pregnancy clinic at 8 weeks of amenorrhoea
with a +ve home pregnancy test. She reports vaginal spotting and pain on intercourse.

A 29-yr old woman is diagnosed with an ectopic pregnancy. There is a 3cm right-sided mass
on USS with a visible fetal heartbeat and no free fluid in the pelvis. The HCG is static at 3500.
She wishes to avoid surgery

The serum BhCG of a symptomless woman with a pregnancy of unknown location (PUL)
has dropped by more than 50% after 48 hours. What is the next step you advise?

A 29-year-old, who is at 6 weeks’ gestation, is diagnosed to have a right tubal ectopic
pregnancy by transvaginal pelvic ultrasound. Which one of the following factors would enable
systemic MTX to be offered as a medical treatment option for the ectopic pregnancy?