EBCOG – PART 1 – EARLY PREGNANCY – DAY 2(EMQ)

A Un ruptured tubal ectopic pregnancy

B Cervical pregnancy

C Cornual pregnancy

D Cesarean scar pregnancy

E Intrauterine pregnancy

F Ruptured tubal ectopic pregnancy

G Missed miscarriage

H Tubo ovarian abscess

I Pregnancy of unknown location

  Each of the following clinical scenarios below relate to of women  with diagnosis of eearlypregnancy .For each patient select the single most option from the list above. Each option may be used once, more than once or not at all.

  1. A 22 year old , with6 weeks gestation with beta Hch is 1500IU/LCame with nausea and vomiting , Transvaginal  scan  reveals endometrial thickness of 20mm , adnexa is normal  no free fluid in POD  

2. A  24  year old with 7 weeks pregnancy with abdominal pain and spotting .She has previous history of surgical termination of pregnancy complicated by infection in post opperiod.her Beta Hcg is 1750IU /LUSG Shows gestational  measuring  25x24mm  present below internal os, with absent sliding sign with vascularity around Gestational sac in Doppler  

3. A 34 year old lady with 8weeks pregnancy with beta hcg of 1200IU /LWith previous cesarean section  She came with spotting  TVS- Gestational sac located anteriorly at the level of the internal os embedded at the site of theprevious lower uterine segment caesarean section scar.doppler showing vascularity around sacEmpty uterine cavity  

4. A 24 year old , 7 weeks  pregnant now Her first  USg report Shows -thin endometrium with no adnexal massBeta -HCG :900IU/L .Usg report after 48 hours: right  adnexal mass: doughnut mass measuring 30x20mm -, no free fluid in POD.   Present Beta-HCG:1600 u/L

5. 22 year old coming with nausea and vomiting , her beta hcg was 1000IU/L, scan showed thickened endometrium no adnexal mass no free fluid Beta hcg after 48 hour  is 1700IU intrauterine gestational sac with ring of fire in right ovary  

A Evacuation of retained products of conception
B Misoprostol
C Misoprostol followed by mifepristone
D Mifepristone followed by misoprostol
E Methotrexate
F Hysteroscopy
G Hysterectomy
H KCI injection to stop fetal heart activity
I Laparoscopy
J Laparotomy
K Laparoscopic saipingectomy
L Repeat ultrasound in I week
M Repeat ultrasound scan by a senior member of staff
N Reassure
0 Termination of pregnancy
P Ultrasound scan by a fetal medicine consultant

Instructions: For each clinical scenario described below, choose the single most appropriate management from the list of options above. Each option may be used once, more than once, or not at all.

6.A 34-year-old woman attends the antenatal clinic for her booking (her first midwife appointment). She had a scan at 9 weeks following vaginal bleeding which showed a fetus with herniation of the gut through the umbilical area. The midwife comes to the registrar for advice as she is worried about the scan report.

7. A 32-year-old woman is referred to the early pregnancy assessment unit at 6 weeks' gestation with mild vaginal bleeding and suprapubic pain. Her urine shows 1 + leucocytes and no nitrates. A transvaginal scan reveals a viable intrauterine pregnancy with subc.horionic bleeding.

8. A 28-year-old woman presents to the early pregnancy assessment unit with mild vaginal bleeding. A transvaginal ultrasound scan shows an intrauterine gestation sac of 14 x 15 x 14 mm with no fetal pole. She is unsure of the date of her last menstrual period.

9. A 34-year-old woman at 7 weeks' gestation is sent to the early pregnancy assessment unit by her GP. Her ultrasound scan confirms a missed miscarriage. She has multiple large fibroids.

10. A 28-year-old woman is referred to the early pregnancy assessment unit with a scan report of a missed miscarriage and she has been clearly informed by the ultrasonographer that the fetal heart beat is absent during the scan. The complete scan report reads as follows: patient's name and hospital number gestational age 10 weeks and 5 days fetal heart action present findings suggestive of missed miscarriage