Suspected ectopic pregnancy — ED assessment OSCE

Candidate instructions

Assess the patient in ED, request appropriate tests, and explain management options. If she deteriorates, manage rupture.

Candidate tasks

1. Focused history (PID, prior ectopic, IVF, IUCD, contraception, pain character).
2. ABC and abdominal/adnexal assessment; recognise instability.
3. Order β-hCG, TVS, FBC, group & save, Rh status.
4. Counsel medical vs surgical pathways with follow-up.
5. State Anti-D if Rh-negative.

Examiner checklist

• Pregnancy test / quantitative hCG + TVS pathway
• Discriminatory zone concept used correctly
• MTX criteria and 50 mg/m² with day 4/7 hCG
• Immediate theatre pathway for shock/rupture
• Anti-D mentioned
• Safety-net for separation pain vs rupture after MTX
• Clear communication and consent elements

Model standard

Stable unruptured ectopic may be eligible for methotrexate 50 mg/m² IM with serial hCG; unstable/ruptured ectopic needs resuscitation and emergency surgery (usually salpingectomy if other tube healthy). Anti-D if Rh-negative. Early scan in future pregnancy.

Common errors

• Sending shocked patient for CT
• MTX without follow-up capacity
• Forgetting Anti-D