MBBS viva · Obstetrics & Gynaecology
Ectopic pregnancy — viva (hCG, TVS, methotrexate, rupture)
Final-prof viva on ectopic pregnancy: risk factors, discriminatory zone, medical criteria and follow-up, surgery choice, Anti-D, heterotopic pregnancy.
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"Amenorrhoea, unilateral pain, spotting, positive pregnancy test — take me through it."
Q1: Diagnosis (2 min)
- Any woman of reproductive age with pain/bleeding → urine β-hCG first.
- Quantitative hCG + TVS; discriminatory zone ~1500–2000 IU/L.
- Empty uterus + adnexal mass ± free fluid = ectopic; pregnancy of unknown location needs serial hCG (expected ~53% rise/48 h in viable IUP is a rule of thumb, not absolute).
- Risk factors: PID/chlamydia, previous ectopic, tubal surgery, IVF, smoking, IUCD pregnancy, genital TB.
Q2: Medical management (2 min)
- Criteria: stable, unruptured, mass usually <3.5 cm, hCG <5000, no cardiac activity, reliable follow-up, no contraindication.[1]
- Methotrexate 50 mg/m² IM; day 4 and 7 hCG with ≥15% fall; weekly to zero.
- Side effects: stomatitis, marrow suppression, hepatitis; separation pain vs rupture safety-net.
- Anti-D if Rh-negative.
Q3: Surgery and rupture (2 min)
- Surgery if unstable, contraindications to MTX, failed medical therapy, heterotopic needing concurrent management, patient preference.
- Salpingectomy preferred if contralateral tube healthy; salpingotomy if sole tube (persistent trophoblast risk).[2]
- Rupture: shock + shoulder tip → ABC, blood, emergency laparoscopy/laparotomy — no imaging delay.
Q4: Special situations (2 min)
- IVF: higher ectopic and heterotopic risk — early TVS of uterus and adnexae.
- IUCD in situ pregnancy: high ectopic proportion; remove IUCD if strings visible after assessment.
- Recurrence 10–15%; early dating scan next pregnancy.
- Methotrexate contraception advice ~3 months.
Key phrases examiners want
- "Pregnancy test every woman of reproductive age with abdominal pain."
- "Methotrexate 50 mg per square metre; 15 percent fall day 4 to 7."
- "Ruptured ectopic is a surgical haemorrhage emergency."
- "Anti-D if rhesus negative."
References2ShowHide
- [1]ACOG. Tubal Ectopic Pregnancy — Practice Bulletin 193. Obstet Gynecol, 2018.PMID 29470343
- [2]Mol F, et al. Salpingotomy versus salpingectomy in women with tubal pregnancy (ESEP study): an open-label, multicentre, randomised controlled trial. Lancet, 2014.PMID 24499812