LE4 - Ectopic Pregnancy

Question 1

A 29-year-old G1P0 presents with 6 weeks of amenorrhea, lower abdominal pain, and spotting. A urine pregnancy test is positive, but transvaginal ultrasound fails to visualize an intrauterine gestational sac. Serum β-hCG levels are 1200 mIU/mL.

Question: What is the most likely diagnosis?
A. Normal early intrauterine pregnancy
B. Ectopic pregnancy
C. Missed abortion
D. Threatened abortion

Follow-Up Question: What is the next best step in management?
A. Perform dilation and curettage
B. Repeat serum β-hCG after 48 hours
C. Administer methotrexate
D. Perform immediate laparoscopy

Answer 1

Question 2

A 32-year-old G2P1 presents to the emergency room with severe lower abdominal pain, shoulder pain, and dizziness. She has a history of tubal surgery and currently has a positive pregnancy test. On examination, she is tachycardic, hypotensive, and has abdominal tenderness.

Question: What is the most likely diagnosis?
A. Appendicitis
B. Ruptured ectopic pregnancy
C. Threatened abortion
D. Ovarian torsion

Follow-Up Question: What is the next step in management?
A. Administer methotrexate
B. Perform an emergency laparotomy
C. Observe and monitor β-hCG levels
D. Administer IV fluids and send the patient home

Answer 2

Question 3

A 25-year-old G1P0 presents with amenorrhea, sharp lower abdominal pain, and vaginal spotting. She uses a progestin-only contraceptive. Transvaginal ultrasound reveals an adnexal mass separate from the ovary and no intrauterine gestational sac. Serum β-hCG is 2500 mIU/mL.

Question: What is the most likely diagnosis?
A. Ectopic pregnancy
B. Ovarian cyst rupture
C. Incomplete abortion
D. Threatened abortion

Follow-Up Question: What is the best management for this patient?
A. Administer methotrexate
B. Perform vacuum aspiration
C. Perform hysteroscopy
D. Observe and repeat β-hCG in 48 hours

Answer 3

Question 4

A 34-year-old G2P0 presents with right-sided abdominal pain, light vaginal spotting, and a history of pelvic inflammatory disease. Her serum β-hCG is 1800 mIU/mL, and transvaginal ultrasound reveals a complex adnexal mass and free fluid in the cul-de-sac.

Question: What is the most likely diagnosis?
A. Ectopic pregnancy
B. Endometriosis
C. Ovarian torsion
D. Corpus luteum cyst

Follow-Up Question: What is the most appropriate next step in management?
A. Administer methotrexate
B. Perform diagnostic laparoscopy
C. Prescribe broad-spectrum antibiotics
D. Perform dilation and curettage

Answer 4

Question 5

A 30-year-old G3P1 presents with 6 weeks of amenorrhea, lower abdominal pain, and spotting. She has been smoking for years and frequently uses vaginal douches. Her serum β-hCG is 2000 mIU/mL, and ultrasound shows no intrauterine pregnancy but a ring of fire sign on Doppler imaging.

Question: What is the most likely diagnosis?
A. Ectopic pregnancy
B. Hydatidiform mole
C. Incomplete abortion
D. Threatened abortion

Follow-Up Question: What is the best management for this patient?
A. Perform immediate laparoscopy
B. Administer methotrexate
C. Observe with serial β-hCG measurements
D. Prescribe progesterone supplementation

Answer 5

Question 6

A 30-year-old G2P1 presents to the emergency room with 6 weeks of amenorrhea, vaginal spotting, and lower abdominal pain. She has a history of pelvic inflammatory disease (PID). A urine pregnancy test is positive, and transvaginal ultrasound shows no intrauterine pregnancy but reveals an adnexal mass.

Question: What is the most likely diagnosis?
A. Normal intrauterine pregnancy
B. Ectopic pregnancy
C. Incomplete abortion
D. Threatened abortion

Follow-Up Question: What is the most appropriate management?
A. Perform dilation and curettage
B. Administer methotrexate
C. Observe and repeat β-hCG in 48 hours
D. Perform emergency laparoscopy

Answer 6

Question 7

A 35-year-old G4P2 presents with 7 weeks of amenorrhea, lower abdominal pain, and light vaginal spotting. She has a history of a previous ectopic pregnancy treated with methotrexate. A serum β-hCG level is 1800 mIU/mL, and ultrasound fails to visualize an intrauterine gestational sac.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Ectopic pregnancy
C. Incomplete abortion
D. Molar pregnancy

Follow-Up Question: What is the next step in management?
A. Administer methotrexate
B. Perform dilation and curettage
C. Administer oxytocin
D. Perform hysteroscopy

Answer 7

Question 8

A 28-year-old G1P0 presents with amenorrhea, lower abdominal pain, and vaginal bleeding. She underwent IVF (in vitro fertilization) for infertility. Transvaginal ultrasound reveals a heterogeneous adnexal mass and free fluid in the cul-de-sac.

Question: What is the most likely diagnosis?
A. Endometriosis
B. Ectopic pregnancy
C. Ovarian cyst rupture
D. Incomplete abortion

Follow-Up Question: What is the best next step in management?
A. Perform emergency laparotomy
B. Administer methotrexate
C. Observe and repeat β-hCG after 48 hours
D. Prescribe broad-spectrum antibiotics

Answer 8

Question 9

A 32-year-old G2P1 presents with 6 weeks of amenorrhea, light vaginal spotting, and shoulder pain. She has been using an IUD for contraception. She reports worsening abdominal discomfort and dizziness. On examination, she is hypotensive and tachycardic.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Ruptured ectopic pregnancy
C. Ovarian torsion
D. Appendicitis

Follow-Up Question: What is the most appropriate immediate management?
A. Administer methotrexate
B. Perform an emergency laparotomy
C. Observe and monitor β-hCG levels
D. Remove the IUD and monitor symptoms

Answer 9

Question 10

A 27-year-old G3P1 presents with 7 weeks of amenorrhea, lower abdominal pain, and spotting. She reports a history of diethylstilbestrol (DES) exposure in utero. Transvaginal ultrasound reveals no intrauterine gestational sac and a “ring of fire” sign on Doppler imaging.

Question: What is the most likely diagnosis?
A. Ectopic pregnancy
B. Hydatidiform mole
C. Incomplete abortion
D. Endometriosis

Follow-Up Question: What is the best management for this patient?
A. Administer methotrexate
B. Perform dilation and curettage
C. Perform diagnostic laparoscopy
D. Administer misoprostol

Answer 10

Question 11

A 28-year-old G1P0 presents with 7 weeks of amenorrhea, vaginal spotting, and mild lower abdominal pain. A serum β-hCG level is 1800 mIU/mL, but transvaginal ultrasound fails to identify an intrauterine gestational sac.

Question: What is the most likely diagnosis?
A. Normal intrauterine pregnancy
B. Ectopic pregnancy
C. Missed abortion
D. Threatened abortion

Follow-Up Question: What is the next step in management?
A. Repeat β-hCG measurement in 48 hours
B. Perform diagnostic laparoscopy
C. Administer methotrexate
D. Perform dilation and curettage

Answer 11

Question 12

A 30-year-old G3P1 presents with 6 weeks of amenorrhea, lower abdominal pain, and vaginal spotting. Serum β-hCG is 2500 mIU/mL, and transvaginal ultrasound reveals a trilaminar endometrial pattern and a complex adnexal mass separate from the ovary.

Question: What is the most likely diagnosis?
A. Hydatidiform mole
B. Ovarian torsion
C. Ectopic pregnancy
D. Threatened abortion

Follow-Up Question: What is the next best diagnostic step?
A. Serum progesterone levels
B. Perform culdocentesis
C. Repeat β-hCG after 48 hours
D. Diagnostic laparoscopy

Answer 12

Question 13

A 32-year-old G2P0 presents to the emergency room with severe lower abdominal pain and dizziness. She has 7 weeks of amenorrhea and a history of previous ectopic pregnancy. Transvaginal ultrasound shows free fluid in the pouch of Douglas and a complex adnexal mass.

Question: What is the most likely diagnosis?
A. Ruptured ovarian cyst
B. Ectopic pregnancy
C. Threatened abortion
D. Endometriosis

Follow-Up Question: What is the immediate management?
A. Administer methotrexate
B. Perform diagnostic laparoscopy
C. Perform suction curettage
D. Prescribe broad-spectrum antibiotics

Answer 13

Question 14

A 29-year-old G1P0 presents with amenorrhea and vaginal spotting. Her serum β-hCG is 2000 mIU/mL, but transvaginal ultrasound reveals no intrauterine gestational sac and an adnexal mass with the bagel sign (echogenic ring with a hypoechoic center).

Question: What is the most likely diagnosis?
A. Normal intrauterine pregnancy
B. Ectopic pregnancy
C. Incomplete abortion
D. Molar pregnancy

Follow-Up Question: What is the best next step in management?
A. Perform diagnostic laparoscopy
B. Administer methotrexate
C. Observe with serial β-hCG levels
D. Repeat transvaginal ultrasound in 48 hours

Answer 14

Question 15

A 33-year-old G2P1 presents with 8 weeks of amenorrhea, vaginal spotting, and mild abdominal pain. Serum β-hCG is 2800 mIU/mL, and transvaginal ultrasound reveals free fluid in the abdomen but no intrauterine gestational sac.

Question: What is the most likely diagnosis?
A. Threatened abortion
B. Incomplete abortion
C. Ectopic pregnancy
D. Hydatidiform mole

Follow-Up Question: What is the definitive diagnostic method for this condition?
A. Serum progesterone measurement
B. Repeat β-hCG after 48 hours
C. Diagnostic laparoscopy
D. Perform dilation and curettage

Answer 15

Question 16

A 30-year-old G1P0 presents with vaginal spotting, mild lower abdominal pain, and lightheadedness. She has a history of a prior ectopic pregnancy treated with methotrexate. Transvaginal ultrasound reveals free fluid in the pouch of Douglas and an adnexal mass. The patient is hemodynamically stable but complains of worsening abdominal pain.

Question: What is the most likely immediate complication in this patient?
A. Pelvic abscess formation
B. Slow, steady intraperitoneal bleed
C. Secondary abdominal implantation
D. Broad ligament bleed

Follow-Up Question: What is the best next step in management?
A. Monitor with serial β-hCG and ultrasound
B. Perform diagnostic laparoscopy
C. Prescribe broad-spectrum antibiotics
D. Administer methotrexate

Answer 16

Question 17

A 28-year-old G2P1 presents with severe lower abdominal pain and dizziness. She is 7 weeks pregnant and has a history of tubal surgery. Ultrasound reveals free fluid in the abdomen but no intrauterine pregnancy. The patient is tachycardic and hypotensive.

Question: What is the most likely cause of her symptoms?
A. Massive intraperitoneal bleed
B. Recurrent ectopic pregnancy
C. Pelvic abscess formation
D. Broad ligament bleed

Follow-Up Question: What is the immediate next step in management?
A. Perform emergency laparotomy
B. Administer methotrexate
C. Observe and monitor hemodynamic stability
D. Repeat β-hCG in 48 hours

Answer 17

Question 18

A 32-year-old G3P1 presents with persistent vaginal bleeding and mild abdominal pain 2 weeks after treatment for ectopic pregnancy with methotrexate. She has no fever or hemodynamic instability. Transvaginal ultrasound shows an echogenic mass in the pelvis with minimal free fluid.

Question: What is the most likely immediate complication?
A. Secondary abdominal implantation
B. Retained ectopic tissue with rebleeding
C. Broad ligament hematoma
D. Tubal rupture

Follow-Up Question: What is the best next step in management?
A. Perform repeat dose of methotrexate
B. Perform diagnostic laparoscopy
C. Observe with serial β-hCG levels
D. Prescribe oral antibiotics

Answer 18

Question 19

A 35-year-old G4P3 presents 6 months after treatment for ectopic pregnancy with complaints of infertility despite regular unprotected intercourse. She has no significant abdominal pain or vaginal bleeding. Her history includes tubal surgery for the ectopic pregnancy.

Question: What is the most likely long-term complication in this patient?
A. Recurrent ectopic pregnancy
B. Pelvic abscess formation
C. Fertility issues due to tubal damage
D. Secondary abdominal implantation

Follow-Up Question: What is the best next step in management?
A. Perform hysterosalpingography (HSG)
B. Administer clomiphene citrate
C. Recommend in vitro fertilization (IVF)
D. Perform diagnostic laparoscopy

Answer 19

Question 20

A 29-year-old G2P1 presents with a history of ectopic pregnancy treated surgically 1 year ago. She now complains of mild unilateral abdominal pain and spotting at 8 weeks of pregnancy. Transvaginal ultrasound reveals a gestational sac in the left fallopian tube and no free fluid.

Question: What is the most likely complication?
A. Recurrent ectopic pregnancy
B. Tubal rupture
C. Secondary abdominal implantation
D. Broad ligament hematoma

Follow-Up Question: What is the best immediate management?
A. Perform diagnostic laparoscopy
B. Administer methotrexate
C. Monitor with serial β-hCG levels
D. Prescribe oral antibiotics

Answer 20

Question 21

A 27-year-old G1P0 presents with 6 weeks of amenorrhea, mild lower abdominal pain, and vaginal spotting. Serum β-hCG is 1200 mIU/mL, and transvaginal ultrasound reveals a 2.5 cm adnexal mass with no fetal cardiac activity. The patient is hemodynamically stable.

Question: What is the most appropriate management?
A. Expectant management
B. Methotrexate
C. Salpingectomy
D. Diagnostic laparoscopy

Answer 21

B. Methotrexate
Rationale: The patient meets criteria for methotrexate: β-hCG <5000 mIU/mL, ectopic size <3.5 cm, and absence of fetal cardiac activity. Methotrexate avoids surgery in stable, unruptured cases.

Question 22

A 30-year-old G2P1 presents with 8 weeks of amenorrhea, sharp abdominal pain, and hypotension. Transvaginal ultrasound shows a ruptured left tubal ectopic pregnancy with free fluid in the abdomen.

Question: What is the most appropriate management?
A. Methotrexate
B. Salpingostomy
C. Salpingectomy
D. Expectant management

Answer 22

C. Salpingectomy
Rationale: A ruptured ectopic pregnancy with hemodynamic instability necessitates salpingectomy to control bleeding and remove the damaged tube.

Question 23

A 25-year-old G1P0 presents with 7 weeks of amenorrhea and vaginal spotting. Serum β-hCG is 1500 mIU/mL and declining on repeat testing. Transvaginal ultrasound reveals a 2 cm ectopic mass with no free fluid in the abdomen.

Question: What is the most appropriate management?
A. Methotrexate
B. Salpingectomy
C. Expectant management
D. Salpingotomy

Answer 23

C. Expectant management
Rationale: Declining β-hCG and an ectopic mass <3.5 cm without free fluid indicate the potential for spontaneous resolution. Expectant management avoids unnecessary intervention.

Question 24

A 28-year-old G2P0 with a history of ectopic pregnancy presents with 6 weeks of amenorrhea and lower abdominal pain. Transvaginal ultrasound shows a 3 cm adnexal mass with no cardiac activity. The patient desires fertility preservation.

Question: What is the best surgical management option for this patient?
A. Salpingectomy
B. Salpingostomy
C. Expectant management
D. Methotrexate

Answer 24

B. Salpingostomy
Rationale: For fertility preservation, salpingostomy is preferred as it allows the fallopian tube to remain intact.

Question 25

A 32-year-old G3P2 with Rh-negative blood type presents with a ruptured ectopic pregnancy at 7 weeks of gestation. She undergoes a salpingectomy.

Question: What additional management is required?
A. Administration of methotrexate
B. Administration of IgG anti-D immunoglobulin
C. Repeat β-hCG monitoring
D. Broad-spectrum antibiotics

Answer 25

B. Administration of IgG anti-D immunoglobulin
Rationale: IgG anti-D immunoglobulin is indicated in Rh-negative women with pregnancy loss to prevent isoimmunization.

Question 26

A 30-year-old G1P0 presents with 8 weeks of amenorrhea, abdominal pain, and mild vaginal spotting. Transvaginal ultrasound reveals an empty uterine cavity and a gestational sac (GS) located >1 cm lateral from the uterine edge. The myometrium surrounding the sac measures 4 mm.

Question: What is the most likely diagnosis?
A. Abdominal pregnancy
B. Cornual/interstitial pregnancy
C. Cesarean scar pregnancy
D. Cervical pregnancy

Follow-Up Question: What is the best initial management for this condition?
A. Expectant management
B. Methotrexate administration
C. Diagnostic laparoscopy
D. Cornual resection

Answer 26

Question 27

A 32-year-old G3P2 presents with 8 weeks of amenorrhea, abdominal pain, and abnormal fetal position on physical examination. Ultrasound shows a fetus separate from the uterus, no myometrium between the fetus and anterior abdominal wall, and extrauterine placental tissue.

Question: What is the most likely diagnosis?
A. Cervical pregnancy
B. Cesarean scar pregnancy
C. Abdominal pregnancy
D. Intra-ligamentous pregnancy

Follow-Up Question: What is the best initial step in management?
A. Perform suction curettage
B. Attempt placental removal during surgery
C. Leave the placenta in situ and monitor with β-hCG and ultrasound
D. Administer methotrexate

Answer 27

Question 28

A 28-year-old G2P1 presents with 7 weeks of amenorrhea, painless vaginal bleeding, and a thin-walled cervix with a partially dilated os. Transvaginal ultrasound reveals a ballooned cervical canal and gestational tissue below the uterine cavity.

Question: What is the most likely diagnosis?
A. Cervical pregnancy
B. Cesarean scar pregnancy
C. Interstitial pregnancy
D. Ovarian pregnancy

Follow-Up Question: What is the best management for this condition?
A. Perform hysteroscopic removal
B. Administer methotrexate
C. Perform suction curettage cautiously
D. Proceed with hysterectomy

Answer 28

Question 29

A 29-year-old G1P0 presents with abdominal pain and vaginal bleeding at 9 weeks of gestation. Transvaginal ultrasound shows a gestational sac implanted in the myometrium at the site of a previous cesarean scar, with no myometrial tissue between the bladder and the sac.

Question: What is the most likely diagnosis?
A. Abdominal pregnancy
B. Cesarean scar pregnancy
C. Cornual pregnancy
D. Cervical pregnancy

Follow-Up Question: What is the best next step in management for this patient?
A. Methotrexate administration
B. Hysteroscopic removal
C. Hysterectomy
D. Expectant management

Answer 29

Question 30

A 35-year-old G2P1 presents with sharp abdominal pain and vaginal bleeding. Transvaginal ultrasound reveals an anechoic area with a wide echogenic ring surrounded by ovarian cortex.

Question: What is the most likely diagnosis?
A. Ovarian pregnancy
B. Cornual pregnancy
C. Abdominal pregnancy
D. Tubal pregnancy

Follow-Up Question: What is the most appropriate management for this condition?
A. Methotrexate
B. Ovarian wedge resection
C. Salpingectomy
D. Diagnostic laparoscopy

Answer 30

Question 31

A 26-year-old G1P0 presents with 6 weeks of amenorrhea, lower abdominal pain, and spotting. Her serum β-hCG is 1200 mIU/mL, and transvaginal ultrasound shows a 2.5 cm tubal mass without fetal cardiac activity. She is hemodynamically stable and desires future fertility.

Question: What is the most appropriate management?
A. Methotrexate administration
B. Salpingectomy
C. Expectant management
D. Laparotomy

Answer 31

A. Methotrexate administration
Rationale: The patient is hemodynamically stable, β-hCG is <1500 mIU/mL, and the mass is <3.5 cm with no fetal cardiac activity, meeting all criteria for methotrexate therapy.

Question 32

A 29-year-old G2P1 presents to the emergency room with 8 weeks of amenorrhea, sharp abdominal pain, and vaginal spotting. She is hypotensive and tachycardic. Transvaginal ultrasound reveals free fluid in the abdomen and a complex adnexal mass measuring 4 cm.

Question: What is the most appropriate immediate intervention?
A. Administer Methotrexate
B. Perform diagnostic laparoscopy
C. Salpingectomy via laparotomy
D. Salpingostomy

Answer 32

C. Salpingectomy via laparotomy
Rationale: The patient is unstable with signs of ruptured ectopic pregnancy. Laparotomy with salpingectomy is indicated to control hemorrhage and remove the damaged tube.

Question 33

A 30-year-old G2P0 presents with 7 weeks of amenorrhea, mild lower abdominal pain, and vaginal spotting. Her serum β-hCG is 800 mIU/mL, and transvaginal ultrasound reveals a 2 cm tubal mass with no fetal cardiac activity. She is hemodynamically stable.

Question: What is the most appropriate management for this patient?
A. Methotrexate administration
B. Salpingectomy
C. Salpingostomy
D. Repeat β-hCG levels in 48 hours

Answer 33

A. Methotrexate administration
Rationale: The patient is stable, and her β-hCG level and tubal mass size meet criteria for methotrexate therapy.

Question 34

A 32-year-old G3P2 presents with 9 weeks of amenorrhea, sharp abdominal pain, and dizziness. Ultrasound reveals a ruptured ectopic pregnancy with free fluid in the abdomen. The patient is tachycardic and has a blood pressure of 80/60 mmHg.

Question: What is the most appropriate immediate intervention?
A. Administer methotrexate
B. Perform laparoscopic salpingectomy
C. Perform laparotomy with salpingostomy
D. Expectant management

Answer 34

B. Perform laparoscopic salpingectomy
Rationale: Although the patient is unstable, laparoscopic salpingectomy is the preferred intervention if the facility has the capability and the surgeon is skilled.

Question 35

A 27-year-old G1P0 presents with 6 weeks of amenorrhea, spotting, and mild lower abdominal pain. Her serum β-hCG is 1600 mIU/mL, and ultrasound reveals a 2.8 cm tubal mass with no cardiac activity. She is hemodynamically stable and prefers a non-surgical approach.

Question: What is the most appropriate management?
A. Administer methotrexate
B. Perform salpingectomy
C. Perform salpingostomy
D. Repeat β-hCG levels and ultrasound in 48 hours

Answer 35

A. Administer methotrexate
Rationale: Methotrexate is appropriate for this stable patient with no fetal cardiac activity, β-hCG <5000 mIU/mL, and a tubal mass <3.5 cm.

Question 36

A 28-year-old G1P0 at 10 weeks gestation presents with abdominal pain, vaginal bleeding, and a history of mild intermittent cramping. On transvaginal ultrasound (TVS), the uterine cavity is empty, and a gestational sac is visualized >1 cm lateral to the uterine edge. A thin myometrial mantle is noted around the sac.

Question: What is the most likely diagnosis?
A. Ovarian pregnancy
B. Abdominal pregnancy
C. Cesarean scar pregnancy
D. Interstitial pregnancy

Follow-Up Question: What is the next step in management?
A. Methotrexate therapy
B. Cornual resection or cornuostomy
C. Perform suction curettage
D. Expectant management

Answer 36

D. Interstitial pregnancy

Question 37

A 34-year-old G3P2 presents at 18 weeks gestation with severe abdominal pain and a palpable abnormal fetal position on physical examination. She reports persistent nausea and an inability to feel uterine contractions. Ultrasound reveals a fetus that is separate from the uterus, with no myometrium between the fetus and the anterior abdominal wall.

Question: What is the most likely diagnosis?
A. Cervical pregnancy
B. Ovarian pregnancy
C. Abdominal pregnancy
D. Intra-ligamentous pregnancy

Follow-Up Question: What is the best approach for management?
A. Perform suction curettage
B. Deliver the fetus and leave the placenta in situ if necessary
C. Administer systemic methotrexate
D. Induce labor with oxytocin

Answer 37

Question 38

A 29-year-old G2P1 at 8 weeks gestation presents with vaginal bleeding and lower abdominal pain. On ultrasound, the uterine cavity is empty, and there is a mass within the ovary that has an anechoic center surrounded by a wide echogenic ring.

Question: What is the most likely diagnosis?
A. Ectopic pregnancy in the ovary
B. Hemorrhagic corpus luteum cyst
C. Abdominal pregnancy
D. Cesarean scar pregnancy

Follow-Up Question: What is the most appropriate next step in management?
A. Ovarian wedge resection or cystectomy
B. Administer methotrexate and observe
C. Perform suction curettage
D. Monitor β-hCG levels weekly

Answer 38

Question 39

A 27-year-old G2P1 presents at 6 weeks gestation with vaginal bleeding and mild lower abdominal pain. Ultrasound shows a gestational sac located in the lower uterine segment with no surrounding myometrium. The cervical canal appears ballooned on imaging, and there is no intrauterine gestational sac.

Question: What is the most likely diagnosis?
A. Intra-ligamentous pregnancy
B. Abdominal pregnancy
C. Cesarean scar pregnancy
D. Cervical pregnancy

Follow-Up Question: What is the next best step in management?
A. Administer methotrexate
B. Perform hysterectomy
C. Suction curettage with close monitoring
D. Induce fetal demise with potassium chloride

Answer 39

Question 40

A 32-year-old G4P2 presents at 7 weeks gestation with vaginal bleeding and mild abdominal pain. She denies passage of tissue. Ultrasound shows an empty uterine cavity with a gestational sac located at the site of a prior cesarean scar. The myometrium between the sac and the bladder is absent.

Question: What is the most likely diagnosis?
A. Abdominal pregnancy
B. Ectopic pregnancy in a cesarean scar
C. Cervical pregnancy
D. Ovarian pregnancy

Follow-Up Question: What is the best management for this patient?
A. Administer methotrexate (systemic or local)
B. Perform transvaginal aspiration
C. Suction curettage
D. Hysterectomy

Answer 40