DRCOG – Module 3 – Early Pregnancy – SBA Questions

A 30-year-old woman presents with severe lower abdominal pain in her first pregnancy.  She is approximately 7 weeks pregnant by her last menstrual period.  Transvaginal ultrasound shows no evidence of an intrauterine pregnancy and no adnexal masses are detected but there is a large volume of free fluid seen in the Pouch of Douglas.  Initial serum β-hCG is 1,200 IU/L. What is the most appropriate management?

A 30-year-old woman presents with mild lower abdominal pain in her first pregnancy.  She is approximately 7 weeks pregnant by her last menstrual period.  Transvaginal ultrasound shows no evidence of an intrauterine pregnancy and no adnexal masses or free fluid are detected.  Initial serum β-hCG is 1,200 IU/L and on repeat 48 hours later, it is 1800 IU/L. What is the most appropriate management?

A 28-year-old woman presents with a positive urine pregnancy test and mild vaginal spotting. Transvaginal ultrasound shows no evidence of intrauterine or ectopic pregnancy. Her serum β-hCG level is 700 IU/L. She is haemodynamically stable with no significant pain. What is the most appropriate management?

A 28 year old nulliparous woman presents with severe lower abdominal pain and vaginal spotting. Her last menstrual period was 8 weeks ago and she has a positive urinary pregnancy test.  She has a history of severe endometriosis for which she has had three previous laparoscopies requiring excision and adhesiolysis. Transvaginal ultrasound shows a retroverted uterus with empty uterine cavity.  Posterior to the uterus in the Pouch of Douglas, there appears to be a gestational sac surrounding by loops of bowel measuring 35x40x33mm with a fetal pole visible with fetal heart beat. The ovaries appear normal, there are no adnexal masses and there is no evidence of free fluid in the Pouch of Douglas. What is the most likely diagnosis?

A 28 year old nulliparous woman presents with lower abdominal pain and vaginal spotting. Her last menstrual period was 8 weeks ago and she has a positive urinary pregnancy test.  She has a history of severe endometriosis for which she has had three previous laparoscopies requiring excision and adhesiolysis. Transvaginal ultrasound shows a retroverted uterus with empty uterine cavity.  The ovaries appear normal, there are no adnexal masses and there is no evidence of free fluid in the Pouch of Douglas. Initial serum b-HCG measurement is 2200 IU/L. What is the most likely diagnosis?

A 41 year old nulliparous woman presents with recurrent painless vaginal bleeding and severe nausea and vomiting of pregnancy at 9 weeks gestation. A transvaginal ultrasound scan is performed which shows an anteverted uterus, with a closed cervix. There was a complex intrauterine mass measuring 60 x55x54 mm containing multiple cystic areas and an area of fluid collection within the uterine cavity. There is no evidence of any fetal tissue. Both ovaries appear morphologically normal with a corpus luteum on the right ovary. What is the most likely diagnosis?

A 41 year old nulliparous woman presents with recurrent painless vaginal bleeding and severe nausea and vomiting of pregnancy at 11 weeks gestation. She has previously had a transvaginal ultrasound which demonstrated a single live intra-uterine pregnancy. A further transabdominal ultrasound confirms absent fetal heart activity which had previously been seen and abnormal enlarged cystic appearances of the placenta. What is the most likely diagnosis?

An 28 year old nulliparous woman presents with severe lower abdominal pain and vaginal spotting. Her last menstrual period was 8 weeks ago and she has a positive urinary pregnancy test.  She has a history of severe endometriosis for which she has had three previous laparoscopies requiring excision and adhesiolysis. Transvaginal ultrasound shows a retroverted uterus with empty uterine cavity.  The right ovary could not be visualised but the left adnexa shows a complex left adnexal mass with mixed echogenicity arising from the left ovary which is tender during scanning.  There is a large amount of free fluid in the Pouch of Douglas. What is the most likely diagnosis?

A 40 year old woman attends her local Early Pregnancy Unit for a reassurance scan due to a history of recurrent miscarriage.  This is an IVF donor egg pregnancy and she is currently 7 weeks pregnant based following the transfer of two blastocysts. Transvaginal scan shows an anteverted uterus with a closed cervix. A gestational sac is seen within the uterine cavity, medial to the interstitial portion of the fallopian tubes measuring 28 x 21 x 29mm. Within the gestational sac is a yolk sac and a fetal pole with a CRL measuring 6 mm but no fetal cardiac activity is seen. Both ovaries appear morphologically normal.  Adjacent to the right ovary is an echogenic ring measuring 18x24x19 mm. There is no evidence of free fluid in the pouch of Douglas. What is the most likely diagnosis?

A 40 year old woman attends her local Early Pregnancy Unit for a reassurance scan due to a history of recurrent miscarriage.  This is an IVF donor egg pregnancy and she is currently 7 weeks pregnant based following the transfer of two blastocysts.  Transvaginal scan shows an anteverted uterus with empty cavity and a closed cervix. Both ovaries appear morphologically normal. Adjacent to the right ovary is an echogenic ring measuring 18x24x19 mm. There is no evidence of free fluid in the pouch of Douglas. What is the most likely diagnosis?

A 40 year old woman attends her local Early Pregnancy Unit for a reassurance scan due to a history of recurrent miscarriage.  She is Para 2 having had two previous emergency Caesarean sections at full dilation.  She is currently approximately 7 weeks pregnant based on her last menstrual period and is asymptomatic.  Transvaginal scan shows an anteverted uterus with empty cavity and a closed cervix. A gestational sac measuring 21mm in diameter is seen at the far upper right lateral aspect of the uterus with a thin echogenic line extending from the central uterine cavity echo to the periphery of the sac.  The sac is surrounded by myometrium measuring a maximum of 4mm in thickness. The adnexa appear normal and there is no free fluid in the Pouch of Douglas. What is the most likely diagnosis?

A 40 year old woman attends her local Early Pregnancy Unit for a reassurance scan due to a history of recurrent miscarriage.  She is Para 2 having had two previous emergency Caesarean sections at full dilation.  She is currently approximately 7 weeks pregnant based on her last menstrual period and is asymptomatic.  Transvaginal scan shows an anteverted uterus with empty cavity and a closed cervix. A gestational sac is seen anteriorly at the level of the internal cervical os and there is prominent blood flow seen on Colour Doppler around the gestational sac.  There is a very thin layer of myometrium between the gestational sac and bladder. What is the most likely diagnosis?

A 40 year old woman attends her local Early Pregnancy Unit for a reassurance scan due to a history of recurrent miscarriage.  She is Para 2 having had two previous emergency Caesarean sections at full dilation.  She is currently approximately 7 weeks pregnant based on her last menstrual period and is asymptomatic.  Transvaginal scan shows an anteverted uterus with a closed cervix. A gestational sac is seen within the uterine cavity, medial to the interstitial portion of the fallopian tubes measuring 28 x 21 x 29mm. Within the gestational sac is a yolk sac and a fetal pole with a CRL measuring 6 mm but no fetal cardiac activity is seen. The adnexae appear normal and there is no free fluid in the Pouch of Douglas. What is the most likely diagnosis?

An 18 year old nulliparous woman presents with lower abdominal pain and vaginal spotting. Her last menstrual period was 6 weeks ago and she has a positive urinary pregnancy test.  Transvaginal ultrasound shows a retroverted uterus with empty uterine cavity.  A small gestational sac measuring 21mm in diameter is seen below the internal cervical os but there is no evidence of a yolk sac or fetal pole.  There is no blood flow seen on Colour Doppler around the gestational sac and sliding sign is present.  The ovaries appear normal with a corpus luteum seen on the left ovary and there is no free fluid in the Pouch of Douglas. What is the most likely diagnosis?

A 40 year old woman presents to her GP after having a miscarriage.She is Gravida 4, Para 0 and has previously been seen in a specialist recurrent miscarriage clinic.  All her investigations have been normal, including a thrombophilia screen, pelvic ultrasound and karyotype.  She requests some new treatment that she has read about online as she is desperate to avoid having a further miscarriage.  Which of the following has been shown to have benefit in unexplained recurrent miscarriage?

A 40 year old woman presents to her GP with vaginal bleeding and cramping lower abdominal pain. She is approximately seven weeks pregnant by her last menstrual period.  Her GP notes her previous gynaecological history: she is Gravida 3, Para 0. She is very upset as she is worried she is having another miscarriage.  Which of the following investigations for recurrent miscarriage should be performed?

A 40 year old woman presents to her GP with vaginal bleeding and cramping lower abdominal pain. She is approximately seven weeks pregnant by her last menstrual period.  Her GP notes her previous gynaecological history: she is Gravida 3, Para 0. She is very upset as she is worried she is having another miscarriage. Which of the following scenarios meets the definition of recurrent miscarriage?

A 40 year old woman presents to her GP with vaginal bleeding and cramping lower abdominal pain. She is approximately seven weeks pregnant by her last menstrual period. Her GP notes her previous gynaecological history: she is Gravida 3, Para 0. She is very upset as she is worried she is having another miscarriage.  What percentage of couples are affected by recurrent miscarriage?

A 40 year old woman presents to her GP with vaginal bleeding and cramping lower abdominal pain. She is approximately seven weeks pregnant by her last menstrual period. She is very upset as she is worried she is having a miscarriage.  What percentage of pregnancies end in miscarriage?

A 26 year old woman presents to her GP with profuse painless vaginal bleeding and severe nausea and vomiting. She is currently 9 weeks pregnant by her last menstrual period.  Her GP refers her to the local Early Pregnancy Unit where a trans-vaginal ultrasound scan shows a suspected molar pregnancy.  She has a surgical evacuation of the uterus and is referred to a gestational trophoblastic disease tertiary centre for follow-up.  Her GP is contacted by the tertiary centre and asked to commence regular monitoring as part of her follow-up.  What is the best method of monitoring for gestational trophoblastic disease?

A 26 year old woman presents to her GP with profuse painless vaginal bleeding and severe nausea and vomiting.  She is currently 9 weeks pregnant by her last menstrual period.  Her GP refers her to the local Early Pregnancy Unit where a trans-vaginal ultrasound scan shows a suspected molar pregnancy.  She has a surgical evacuation of the uterus and is referred to a gestational trophoblastic disease tertiary centre for follow-up.  She represents eight weeks later to her GP with frank haemoptysis.  What is the next most appropriate management?

A 26 year old woman presents to her GP with a positive pregnancy test.  She is unsure when her last menstrual period is because she has an intra-uterine contraceptive device (IUCD) in situ.  She has no abdominal pain or vaginal bleeding and is asymptomatic. She is otherwise fit and well with no other significant past medical history.  What is the most appropriate management?

A 26 year old woman presents to her GP with a positive pregnancy test to book for routine antenatal care.  Her last menstrual period was 8 weeks ago.  She has no abdominal pain or vaginal bleeding and is asymptomatic. She has previously had an ectopic pregnancy two years ago which was managed with methotrexate injections and subsequently resolved.  She is otherwise fit and well with no other significant past medical history.  What is the most appropriate management?

A 26 year old woman presents to her GP with vaginal bleeding and cramping lower abdominal pain.  She is approximately 9 weeks pregnancy by last menstrual period.  Her GP refers her to the local Early Pregnancy Unit for assessment where she is diagnosed with an incomplete miscarriage. Which of the following is a risk factor for miscarriage?

A 26 year old woman presents to her GP with vaginal bleeding and cramping lower abdominal pain. She is approximately 9 weeks pregnancy by last menstrual period.  Her GP refers her to the local Early Pregnancy Unit for assessment.  Which of the following is not a risk factor for miscarriage?

A 26 year old woman presents to her GP with a 10 day history of left sided lower abdominal pain.  She is usually fit and well with no significant past medical history.  Her GP does a urinary pregnancy test which is positive.  Which of the following is not a risk factor for ectopic pregnancy?

A 26 year old woman presents to her GP with a 10 day history of left sided lower abdominal pain.  She is usually fit and well with no significant past medical history.  Her GP does a urinary pregnancy test which is positive.  Which of the following is not a risk factor for ectopic pregnancy?

A 26 year old woman presents to her GP with a 10 day history of left sided lower abdominal pain, vomiting and loose stools. She is usually fit and well but is known to have uterine fibroids.  Her last menstrual period was 8 weeks ago.  On examination, her abdomen is soft but she has a bulky enlarged uterus of approximately 14 week size with palpable fibroids.  Her urinary pregnancy test is positive and her GP refers her urgently to the local Early Pregnancy Unit.  What is the next most appropriate investigation?

A 24 year old woman presents to her GP with vaginal bleeding.  She is approximately five weeks pregnant by her last menstrual period and her urinary pregnancy test is positive on assessment by her GP.  She denies abdominal pain and abdominal and bimanual examination is unremarkable.  Her GP advises her to monitor her symptoms and repeat a urinary pregnancy test in 7-10 days.  She then represents two days later to the Out-Of-Hours GP service with increased vaginal bleeding and cramping lower abdominal pain. What is the most appropriate management?

A 24 year old woman presents to her GP with vaginal bleeding.  She is approximately five weeks pregnant by her last menstrual period and her urinary pregnancy test is positive on assessment by her GP.  She denies abdominal pain and abdominal and bimanual examination is unremarkable.  Her GP advises her to monitor her symptoms and repeat a urinary pregnancy test in 7-10 days.  She then represents two days with increased vaginal bleeding and cramping lower abdominal pain.  Her observations including pulse and blood pressure are normal.  What is the most appropriate management?

A 26 year old woman presents to her GP with a 10 day history of left sided lower abdominal pain, vomiting and loose stools. She is usually fit and well with no significant past medical history.  Her last menstrual period was 8 weeks ago.  On examination, her abdomen is soft but she has localized peritonism in the left iliac fossa and tenderness in the left adnexae on bimanual examination.  Her urinary pregnancy test is positive.  What is the next most appropriate investigation?

A 24 year old woman presents to her GP with right sided lower abdominal pain. She is approximately eight weeks pregnant by her last menstrual period and her urinary pregnancy test is positive on assessment by the GP.  She has not had any vaginal bleeding and abdominal and bimanual examination is unremarkable.  Her observations are: BP 95/45, P 130, RR 24, Sats 98% RA, Temp 36.8C.  What is the next most appropriate investigation?

A 24 year old woman presents to the out-of-hours GP with severe right sided lower abdominal pain. She is approximately eight weeks pregnant by her last menstrual period and her urinary pregnancy test is positive on assessment by the GP.  She has not had any vaginal bleeding and abdominal and bimanual examination elicits severe abdominal pain.  Her observations including pulse and blood pressure are normal.  What is the next most appropriate management?

A 24 year old woman presents to her GP with right sided lower abdominal pain. She is approximately eight weeks pregnant by her last menstrual period and her urinary pregnancy test is positive on assessment by the GP.  She has not had any vaginal bleeding and abdominal and bimanual examination is unremarkable.  Her observations including pulse and blood pressure are normal.  What is the next most appropriate management?

A 24 year old woman presents to her GP with vaginal bleeding. She is approximately eight weeks pregnant by her last menstrual period and her urinary pregnancy test is positive on assessment by her GP.  She denies abdominal pain and abdominal and bimanual examination is unremarkable.  Her observations including pulse and blood pressure are normal.  What is the next most appropriate management?

A 24 year old woman presents to her GP with vaginal bleeding. She is five weeks pregnant by her last menstrual period and her urine pregnancy test is positive.  She denies abdominal pain and abdominal and bimanual examination is unremarkable.  What is the next most appropriate management?

A 40 year old woman presents to her GP with vaginal bleeding and cramping lower abdominal pain. She is approximately seven weeks pregnant by her last menstrual period.  Her GP notes her previous gynaecological history: she is Gravida 3, Para 0. She is very upset as she is worried she is having another miscarriage.  Which of the following is not associated with recurrent miscarriage?

A 26 year old woman presents to her GP with a 10 day history of left sided lower abdominal pain, vomiting and loose stools. She is usually fit and well with no significant past medical history.  On examination, her abdomen is soft but she has localized peritonism in the left iliac fossa and fullness and tenderness in the left adnexae on bimanual examination.  What is the next most appropriate investigation?

A 15 year old girl attends the Early Pregnancy Assessment Unit at approximately six weeks pregnant and ultrasound scan confirms a missed miscarriage. She wishes to have surgical management and signs a consent form for the procedure.  Which of the following statements about consent is incorrect?

A 20 year old woman attends her GP at 7 weeks gestation in her first pregnancy with persistent nausea and vomiting for the last week. Her GP diagnoses nausea and vomiting of pregnancy.  What is the most appropriate antiemetic regimen?

A woman in her first pregnancy is diagnosed with a missed miscarriage at 8 weeks gestation and opts for manual vacuum aspiration.  What cervical preparation should be given before the procedure?

A woman in her first pregnancy is diagnosed with a missed miscarriage at 8 weeks gestation and opts for manual vacuum aspiration. Which of the following is not routinely used for analgesia for this procedure?

What is the incidence of ectopic pregnancy in the UK?