GP CCE Cases · pregnancy-and-reproductive-health
Bleeding at six weeks with an empty uterus — CCE clinical encounter
CCE-style clinical encounter: a 30-year-old woman with light bleeding and a positive pregnancy test whose scan shows an empty uterus with hCG 1750 IU/L. The candidate must manage the PUL protocol, avoid premature labelling, and deliver compassionate safety-netting.
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Study tools
Target exams
RACGP CCEFRACGP oralsCFPC SOOs
Prompt
A 30-year-old teacher attends anxious after noticing spotting this morning. Urinary hCG positive; six weeks since LMP; mild cramps. TVS in the practice shows an empty uterus. Serum hCG drawn today: 1750 IU/L. Observations stable, no shoulder-tip pain, abdomen soft.
Objectives
- Explain the PUL situation honestly — too early to locate, not safe to dismiss. [1]
- Set the 48-hour hCG and rescan pathway with early pregnancy unit contact details. [1]
- Safety-net explicitly for ectopic rupture (pain, shoulder tip, collapse) and heavy bleeding. [1]
- Prepare her for the possible outcomes: viable pregnancy, miscarriage (and its three management routes), or ectopic requiring treatment. [2]
- Acknowledge anxiety and provide written follow-up instructions. [2]
References2ShowHide
- [1]Jurkovic D, Memtsa M, Sawyer E, et al. Single-dose systemic methotrexate vs expectant management for treatment of tubal ectopic pregnancy: a placebo-controlled RCT Ultrasound Obstet Gynecol, 2017.PMID 27731538
- [2]Nanda K, Lopez LM, Grimes DA, et al. Expectant care versus surgical treatment for miscarriage Cochrane Database Syst Rev, 2012.PMID 22419288