The Diagnosis and Management of Ectopic Pregnancy

1. Mrs. X has presented with lower abdominal pain and vaginal spotting. Her pregnancy test is positive. She is hemo-dynamically stable. You request for transvaginal scan. At what minimum level of Beta Hcg , intrauterine pregnancy should be visible on scan

2. Mrs. X has presented with lower abdominal pain and vaginal spotting. Her pregnancy test is positive. Her Beta-Hcg is 900 IU/L . You request for transvaginal scan, but uterine cavity is empty. Adnexa normal. When you should be repeating Beta-Hcg to understand doubling time ?

3. After ovulation, how early is Beta-Hcg detectable in maternal serum?

4. Mrs. X, has done a home pregnancy test 2 days back, which is positive. Transvaginal ultrasound shows presence of non-homogenous adnexal mass. Her beta hcg is 750 IU/ L. She is asymptomatic. So after 2 days beta hcg repeated and is 350 IU/ L. Even now she is asymptomatic. What is appropriate management for her ?

5. Systemic Methotrexate is a safe and effective treatment for Ectopic pregnancy, what is the mechanism of action of Methotrexate ?

6. Systemic Methotrexate is a safe and effective treatment for Ectopic pregnancy. All are contraindications for Methotrexate except

7. Mrs. X, 32 years old woman, primigravida and now 6 weeks pregnant. Her transvaginal scan shows right adnexa mass of 36x25x30mm with fetal cardiac activity present. Her beta hcg is 1570IU/L. She is asymptomatic and hemodynamically stable. What is the appropriate management ?

8. Salpingectomy is recommended for all the following conditions of ectopic pregnancy except

9. Mrs. X, 30 years old in her second pregnancy, previous baby delivered by cesarean section at full dilatation. Now she is 6 weeks pregnant; presented with lower abdominal pain and spotting. Transvaginal Ultrasound shows a gestation sac distal to a closed internal cervical os. Doppler shows increased vascularity around gestational sac. Sliding sign is absent, what is the probable diagnosis?

10. Mrs. X is primigravida with 6 weeks pregnancy diagnosed to have ectopic pregnancy. Her blood group is A negative, she is sensitised a roofing to serum antibody screening.

What advice regarding Anti D needs to be given ?